Clinical Consultation Request Form

Clinical Consultation Info

When a therapist submits a consultation form, our Clinical Director reviews the information, provides an initial case conceptualization with recommendations for support, and connects the therapist with the most appropriate consultant. The therapist then receives feedback and next steps, along with details for scheduling. Clinical consultations are $200 per 50-minute session.

What is the client’s age and presenting concerns?

How long have you been working with this client?

What has prompted you to seek consultation now?

What treatment modalities/interventions have been tried so far?

What assessment tools/measures have you used? What do they suggest?

What is your working diagnosis (if any)?

How have you been conceptualizing this case over time?

What other providers/supports are involved in the client’s care?

Notes: Anything else we should know?

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