Name *

First Name

Last Name

Phone

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I understand Sabrina Mueller, LMHC (Sabrina Mueller Counseling) has limited evening hours and is not available on weekends. Hours available for appointments are generally during the week Monday-Friday 9am-3pm, Tuesday and Wednesday evenings 4-6 pm. *

Agree

I understand Sabrina Mueller, LMHC (Sabrina Mueller Counseling) is a fee for service practice and does not participate directly with insurance networks. I understand I am responsible for my full fee for sessions at the time of service. If I think I may qualify for reimbursement with my Out of Network benefits I understand that I can submit information to my insurance company to see if they may reimburse me for my sessions. I am welcome to discuss this and ask any questions about this during the time of my consultation call. *

Agree

I understand that electronic communications such as this one are limited in terms of privacy and may be intercepted by a third party. I understand by completing this form and submitting my information I am choosing to submit my information this way and release Sabrina Mueller, LMHC (Sabrina Mueller Counseling) from any and all liability. *

Agree