New Patient Availability

Thank you for reaching out regarding counseling services. We appreciate your interest and are excited about the opportunity to explore whether our practice may be a good fit for your needs. Before scheduling, we would like to gather a few details to help us determine provider availability and verify whether we are in-network with your insurance plan. This information will allow us to match you with a provider whose schedule, expertise, and services best align with your needs. Once we receive the requested information, we will review it and follow up via email from sdinan@mentalhealthcounselingofnazareth.com with available appointment options. Please be assured that all information you provide will remain confidential and will not be shared or used for any purpose other than assisting with the scheduling and intake process. Thank you for considering Mental Health Counseling of Nazareth. We look forward to hearing from you and assisting you on your journey toward wellness.

610-504-7776

First and Last Name of patient

Date of Birth

Email address

Best phone number to reach you at:

*I will contact you via e-mail, phone number is secondary if necessary*

Home Address (this will allow me to look up your benefits):

Name of insurance company (if you do not have insurance, no problem, we are happy to offer reasonable rates)

Please note that at this time we are not in-network with Medicaid or Medicare*

Member ID:

Type of appointment

Virtual

In-person

Brief summary of what brings you to counseling

What time(s) would work best for you on Mondays? All appointments are appx 60 min

*Typical office hours on Mondays are: Macy Lluberes 8:30am-1:30pm*

What time(s) would work best for you on Tuesdays? All appointments are appx 60 min

*Typical office hours on Tuesday are: Sarah Dinan, LPC 8:30am-6:30pm/ Macy Lluberes 8:30am-1:30pm *

What time(s) would work best for you on Wednesdays? All appointments are appx 60 min

*Typical office hours on Wednesdays are: Sarah Dinan, LPC 8:30am-2:00pm/ Macy Lluberes 8:30am-1:30pm*

What time(s) would work best for you on Thursdays? All appointments are appx 60 min

*Typical office hours: Sarah Dinan, LPC 8:30am-6:30pm/ Macy Lluberes 10:00am-6:00pm *

What time(s) would work best for you on Fridays? All appointments are appx 60 min

*Typical office hours on Fridays are: Sarah Dinan, LPC 8:30am-2:00pm/ Macy Lluberes 8:30am-1:30pm *

If there is a provider you prefer please list their name. If you have no preference please indicate "No Preference"

How were you referred?

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New Patient Availability

610-504-7776