Therapy Inquiry Form

Emergency Assistance

If this is an emergency, call:

National Crisis Line: 988
Local Crisis Line: 801-587-3000
911

Thanks for your therapy inquiry. A few details about my practice that you'll want to know:

I am currently seeing clients for virtual and in-person sessions from my Salt Lake City location.

My rate is $130 per 50 minute sessions and $195 for 80 minute sessions.

I am no longer accepting new insurance clients. However, we provide paperwork that allows you to seek reimbursement directly from your insurance company. We will not submit this paperwork to your insurance company on your behalf.

Client Information

First name

Last name

Contact Information

Phone number

Email address

How may we contact you?

Phone

Voicemail

How did you find out about Janna McGaw LCSW? (If an existing client, please do not include their name)

Have you previously received therapy?

Yes No

If yes, for what reasons?

Are you currently or have you ever been suicidal? Please explain.

Have you ever been hospitalized for mental health issues?

Yes No

If Yes, please provide more information.

If Other, please specify:

Please tell us about what you are hoping to accomplish in therapy? What are the challenges you are dealing with that are prompting you to reach out for help?

Is there anything else you'd like to tell us about?

After receiving your information, we will review and respond via email or phone.

Your information will be encrypted.