New Client Form

Hi there,

Thanks for reaching out, please complete this form and we will get back to you within 48-hours to get you setup for a consult.

Current availability:

Mike: Full, currently taking a wait-list and open to intensives

Robert: limited

Stephen: limited

Upcoming Events:

5th Annual Men's Retreat registration is open, check it out here.

Adventure Retreat registration opening in May.

Take care and talk soon,

Mike

First name

Last name

Date of birth

Email address

Cell phone number

What are you looking to confront, address, and/or accomplish?

How would you like to work? Our in-person office is in Royal Oak, MI

In-person therapy only

(All staff)

Virtual therapy only

(Stephen only)

Hybrid/Mix of both

(Stephen only)

I am also interested in men’s group and/or retreats

Intensive (half-day intensive work with Mike)

When are your preferred times to meet? (Select all that apply)

Mornings

Afternoons

Evenings

Saturdays

(Robert only)

Therapy History

Have you been in therapy in the last 12 months?

Yes No

If yes, what was your past experience like? What was helpful and not helpful?

To help expedite the on-boarding process, you can attach your insurance card here on our secure and encrypted form. We will run a courtesy check on your benefits. This can be done later but will help with getting you into the system and into therapy faster if attached now. Thank you!

Add file

Please upload a file

Were you referred by someone? if yes, please share their name/organization below:

May I add you to our quarterly newsletter?

Yes No thanks

Thank you and chat soon.

Mike Lamerato MS, LPC

Founder and Primary Therapist

Metro-Detroit Men's Therapy

Robert, Mike, and Stephen

Your information will be encrypted.

New Client Form

Annual Retreat Registration is open

Annual Retreat Registration is open

Hours of Operation