New Client Form

Michael J. Lamerato MS, LLP, LLPC

Please correct the errors described below.

Client Information

*Hi there, unfortunately I am currently full, if you would like to be put on the wait list, please fill out the form below. You are also welcome to schedule a free consult if you would still like to see if we would be a good for for therapy in the future.

Thank you,

Mike

Welcome, please complete the form below ***and also select your free consult time with the link at the end of the form. Thank you and I look forward to speaking with you!

Therapy History

I currently take the insruances listed here and also offer private pay rate of $130 per 50-minute session
***Thank you, lastly, use link below to schedule your free consult and then submit form.

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