New Client Form

Hi there,

Thanks for reaching out, please complete and submit the form below. Mike will then get you back to you within 48 hours to get you setup.

*Please note our current availability: We are currently all at capacity, if you would like to be placed on the wait-list, please complete this form and we will get back to you when spots open up. Current lead time is about one month.

Mike: wait-list

Robert: wait-list

Stephen: limited

Upcoming Events:

Annual Retreat goes live 4/15

Take care and talk soon,

Mike

First name

Last name

Date of birth

Email address

Cell phone number

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

In-person therapy only

Virtual therapy only

Hybrid/Mix of both

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

Intensive (1-day intensive work with Mike)

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

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 goes live 4/15

*Annual Retreat goes live 4/15

Hours of Operation