Establish Care

Emergency Assistance

If this is an emergency, call:

Where did you hear about us?

Client Information

First name

Last name

Date of Birth

Gender

Email address

Phone number

Address

I will create your patient portal account. You will receive an email from Theraplatform to change your password. From there, you will be able to login and schedule your first appointment. For scheduling assistance, please email me.

Is Minor

First Name of Parent or Legal Guardian

Last Name of Parent or Legal Guardian

Date of Birth

Gender

Email address

Phone Number

Address

If the patient is a minor, please fill in the parent/guardian information.

Reimbursement for Services

Plans

Private Pay Autism, IQ Testing

5 sessions and written report.

Private Pay Autism, IQ, and ADHD Testing

5 sessions and a written report.

Private Pay ADHD Testing

3 sessions and written report. Includes IQ testing.

About Your Appointment

Additional information

Describe the reasons you are seeking out therapy, your goals for treatment, and any stressful life events that you are currently experiencing. Add anything else you would like for me to know.

Upload files including previous psychological or neuropsychological tests.

Add file

Please upload a file

Your information will be encrypted.

Establish Care

Emergency Assistance

Client Information

Reimbursement for Services

About Your Appointment

Emergency Assistance

Kristen Math

Owner/Therapist, Therapy Dynamics PLLC