New Client Form

Spring Rucking Group and 5th Annual Retreat will be announced at the end of March

Hi there,

Thanks for reaching out, please complete the form below and also pick a consult time with Mike to get started.

*Please note our current availability:

Mike: not currently taking individual clients but is open for intensives

Robert: Limited

Stephen: Taking new clients

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

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

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.

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

*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

Your information will be encrypted.

New Client Form

Spring Rucking Group and 5th Annual Retreat will be announced at the end of March

*Please pick your consult time here

Spring Rucking Group and 5th Annual Retreat will be announced at the end of March

Hours of Operation