Request appointment | True-Self Therapy

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Insurance details

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Insurance card upload

Upload a photo of your insurance card

Please include the name, email, and the relationship of the person who will be financially responsible for your services. This is typically, the person who holds your insurance or a parent/legal guardian. If you are over 18, you may put yourself.

Financially Responsible Party's Full Name

Financially Responsible Party's Email:

Financially Responsible Party's Relationship

Self Dependent Family Member Legal Guardian Physician Parent Partner Spouse Other

If you have concerns about the person financially responsible for your care knowing that you are receiving treatment, please let us know below and we will discuss your options

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If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.