New Client Form

Hi there,

Thanks for reaching out, please complete the form below and also pick a consult time and Mike will get you taken care of from there.

*Please note our current availability:

Mike: limited capacity, open for intensives

Robert: Taking new clients

Stephen: Taking new clients

Take care and talk soon,

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 work? Our in-person office is in Royal Oak, MI, Monday-Saturday

In-person therapy only

Video therapy only

Hybrid/Mix of both

Intensive (1-day intensive work with Mike)

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

Saturdays

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 our quarterly newsletter?

Yes No thanks

*Please pick your consult time here

*Please make sure you submit this form below before closing out.

Thank you and chat soon.

- Mike Lamerato

Founder and Primary Therapist, Metro-Detroit Men's Therapy

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