Relationship Intensive Intake Request

I understand that deciding to go to therapy is a big step, and often comes with some questions.

Please fill out this form in order to begin your Relationship Intensive Intake process. Once received, you'll be contacted via email to set up your free consultation call to help you decide if a Relationship Intensive is right for you and your partner(s).
**** CONFIDENTIALITY NOTICE ****
Please note: GoogleDocs, GoogleForms, and/or email are not secure or confidential ways to communicate. Never send sensitive or confidential information via these formats unless you have carefully considered the risks in doing so.
Please only use this GoogleForm to request an intake appointment if you have considered the confidentiality risks of doing so. If you would prefer, you can email b@rootedinchangetherapy.com instead and share that you are looking to move forward with a relationship therapy intensive.


E: b@rootedinchangetherapy.com
P: 734.999.0070

What would life look like if you were living authentically, connected within your relationships, and experiencing life in new ways?

LGBTQ+ Therapy

You have had the experience of seeing a counselor who has no clue how to support someone with your lived experience and are sick of searching. You may be struggling with your identity but the real struggle is dealing with society and family expectations. 

Polyamory Therapy

If you are asking am I poly (polyam) you have come to the right place. If you have already started to dig into resources and need a therapist to guide you on the journey of opening your relationship an open relationship affirming therapist can help you along the way.

Sex Therapy

Our culture has not set us up for success in sexual connection with ourselves or partners. Sex therapy enables you to build a safer space with your therapist and begin to explore whatever aspects of your sexual functioning you want to address.

MORE ABOUT HOW WE CAN WORK TOGETHER

Frequently Asked Questions

  • I live and work in SE Michigan. I am able to work with clients anywhere in the state of Michigan.

  • No. To understand why I have chosen not to accept insurance please see the following

    ​Privacy- I value my clients privacy and part of that is protecting it from insurance companies. Insurance companies can request notes and require a diagnosis for them to deem your services "medically necessary".

    Control- When using insurance, they dictate medical necessity, how much they are willing to pay, and how often you can receive therapy. As the insurance member, the quality of care is limited to what or whom the insurances can offer.

    Diagnosis – It is mandatory for a therapist to provide a mental health diagnosis when using insurance as payment for services. Without a diagnosis, the therapist will not be able to submit a bill for insurance payment reimbursement. This diagnosis is to be made within one session. I do know that for many people having a diagnosis can be useful and even therapeutcally relevant but I do not believe it should be mandated and controlled by insurance companies.

  • I do not offer in person sessions at this time.

  • Please visit my Fees page for current rates for services.

  • After you schedule your intake session you will receive your invite to a portal to complete your paperwork. The paperwork is a mix of the legal things that we need to go over like informed consent and practice policies, and the personal intake questionnaire. Your intake questionnaire gives me more information about you, the systems that impact your life, your family of origin, and the problem you are bringing to therapy. Due to the sensitive nature of therapy I allow for questions to be skipped and gone over in a session instead. By completing the paperwork before the session we can ensure that our time together is spent discussing the reasons you are coming to therapy.

    Once you have completed your paperwork I will send you an invite via IvyPay, a HIPAA compliant payment processing platform. Once that is complete we will meet for our intake session where we will begin the assessment process. This is a place to get to know you and better understand your goals of therapy and what you are hoping to get out of the sessions. Some folks come in and want to spill their guts, other people take a bit of time to warm up and trust me before going deep. I am there to meet you where you are and honor your unique experience of therapy. Reach out today with questions or schedule now!

  • This is a difficult question to answer. It all depends on what you are seeking therapy for, the size of the problem(s), and whether or not you are coming to therapy as an individual or part of a couple/relationship. Please feel free to discuss this with me at any time.

  • As a private-pay therapist I accept all major credit/debit cards as well as FSA and HSA cards. I do not accept health insurance, cash, check, or money order. 

  • I have limited sliding scale/low fee spots that you are welcome to inquire about. These spots are highly sought after and are nearly always full with long term clients.

    ​If you are unable to afford paying for weekly services, out-of-pocket, here are some alternative options: 

    a) Bi-weekly sessions – Counseling services can be provided bi-weekly. This allows for clients to spread out services in a way that creates more financial balance instead of attending to weekly sessions.

    b) FSA/HSA Visa Cards – If your insurance has provided you with a Visa Card, you can use either of these accounts to pay for services because therapy is a medical expense.Item description

  • No, I do not charge late fees. You are still held responsible for paying the fee for service that you scheduled as this time was held exclusively for you, and only you. I provide all clients with a grace period, where I will hold a partial session if you arrive no more than 10-minutes late. If you are going to be later than 10 minutes please notify me as soon as possible. Please note, you will still be charged a full session rate and no time will be added to this session.

  • Everyone is entitled to cancel/reschedule their session for whatever reason. All clients must contact me via the portal to put in such request at least 24 hours before their scheduled appointment. If this request is received before 24 hours, there is no fee. However, if request is received after this timeframe, you will be charged a cancellation fee that is equal to the cost of a full session.