Thrive Mental Health and Wellness

Who would be receiving care?

My partner and me

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Sex at birth

For insurance verification

State

Select the state you live in

Reason for care

What are you currently seeking counseling for?

Please provide 1-2 sentences or a few words regarding what brings you to counseling at this time. This will help us ensure you are matched with the appropriate clinician.

Limited to 600 characters

How did you hear about our services?

Billing & Payment

Are you using insurance for services? If so indicate your provider.

Please note the following regarding insurance: Alysia Kelley: In Network w/Aetna & Cigna; Anthony Crawley: In Network w/Aetna & Cigna; Julianna Graziani: Self Pay only (reduced fee of $45 per session). If you have BCBS or United, we can look up your Out of Network coverage and submit claims as on Out of Network Provider for you. We will provide this information before your appointment.

Aetna Blue Cross/Blue Shield Cigna United Self Pay

Insurance card upload

Upload a photo of your insurance card

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.