New Client Form

Metro-Detroit Men’s Therapy

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Winter Retreat and Group Registration is live

Hi there,

Thanks for reaching out, Mike's schedule is currently full but his associate Robert is taking new clients (BCBS or private pay only) If you are interested in working with him, complete this form and he will reach out directly for a consult to get you started.

Our eight-week, Winter Men's Group starting at the end of January, check it out here. It is a great way to get some work done in a group setting.

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

How would you like to pay for sessions?

*I currently take the insurances listed here. The cash rate is $175/session. Please note that we are not paneled Medicaid. We are happy to check out of network benefits

Who would you like to work with?

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

May I add you to our quarterly newsletter?

Yes No thanks

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Winter Retreat and Group Registration is live

Hours of Operation

Monday-Thursday 10a-7p Friday 9a-5p Saturday by appointment

metro_detroit_mens_therapy
1320 N. Campbell Rd., Suite 6, Royal Oak, MI, 48067, US

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