Request an Appointment

Emergency Assistance

If this is an emergency, call:

Crisis Line: (800) 981-4357
911

If you are not a client and would like to make a referral, please stop and use the link below.
https://hushforms.com/elephantroomcounseling_referral

Client Information

First name

Last name

Pronouns

Email address

Phone number

Due to licensure and regulations, we can only see clients who are physically in MA. Can you confirm that you will be in MA during virtual sessions? We only offer virtual sessions at the moment

Yes No

We cannot accept clients who are outside of MA

Are you looking for a therapist who specializes in working with Asian/Asian-American?

Yes No

Do you prefer a therapist who can understand one of the following languages? Current available languages

No preference

Cantonese

Mandarin

Korean

Thai

Vietnamese

Insurance Name

Each therapist has different contracts with the insurance companies. Superbill is available for out-of-network plans.

Insurance Policy Number

Date of birth (For insurance verification)

Copy of insurance card - Front and back You may be asked to email it if we cannot verify your insurance based on the info you have given.

Add file

Please upload a file

Preferred day(s)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferred time(s)

Early morning (6 - 9 am)

Mid morning (8 - 10 am)

Late morning (10 am - noon)

Early afternoon (noon - 2 pm)

Mid afternoon (2 - 4 pm)

Late afternoon (3 - 5 pm)

Evening (6 - 9 pm)

Late evening (9 pm - midnight)

Reasons for your request

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Elephant In The Room Counseling

Founded by a group of compassionate Asian American Clinical Social Workers, Elephant in the Room Counseling recognizes the limit of behavioral health services in Asian communities and strives to help fill that gap. Equipped with strong clinical skills and cultural/linguistic expertise, we are dedicated to empowering and improving access to behavioral health for individuals from underserved communities while acknowledging and embracing cultural differences.

(617) 657-3381‬
www.elephantroomcounseling.com
859 Willard Street, Suite 400, Quincy, Massachusetts, 02169, United States