Name *

First Name

Last Name

Phone *

(###)

###

####

Can we text you? *

Yes

No

What kind of therapy are you interested in? *

Couples

Individual

Family

Partner's Name (if applicable)

First Name

Last Name

Location *

I am interested in virtual appointments only

I am interested in in person appointments only

I'm open to virtual or in person appointments

Please check the following boxes to confirm: *

Rates are based on therapist's experience and specializations. Not all lower fee therapists are a fit for all types of client needs. Our intake team will ensure you're matched with the best fit for you.

I understand Jorddana's fee is $175/session and insurance is not accepted.

I understand Jorddana is not eligible for out of network reimbursement.

Where are you located? *

New York

Florida

Other