New Client Form

Hi there,

Thanks for reaching out, Mike’s caseload is currently full and Robert has limited availability. Our colleague and friend Mark Strubler may have openings at his practice if you’d like to also check with him here.

I also have a current Master's level intern, Stephen who is taking clients for discounted private pay sessions and he will also be paneled with BCBS this coming January. Please select that option below if you would be open to this, he is a great clinician and is supervised by me.

Upon completion of the form, you will be offered times for a free consult in which I would be happy to chat and get you setup.

*Our next men’s workshop is also live and will center around courageous parenting and will feature a local parenting expert. Check it out here: https://michael-lamerato.mykajabi.com/men's-fall-workshop-courageous-parenting

Take care,

Mike

First name

Last name

Date of birth

Cell phone number

Email address

What brings you to therapy/what are your current biggest concerns?

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

In-person only

Video/Online only

Hybrid/Mix of both

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

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

Mornings

Afternoons

Evenings

Therapy History

Have you been in therapy in the last 12 months?

Yes No

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

May I add you to my quarterly newsletter?

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New Client Form

Fall Men's Workshop is live

Fall Men's Workshop is live

Hours of Operation