Request an Appointment

We are excited for our future together

Any client 18 years or older needs to complete their intake forms in order for us to accept them. Please only complete one intake form per client. Thank you for choosing Think Happy Live Healthy.

We are not currently accepting therapy clients under age 6.
For medication management we cannot accept any clients under 16 for ADHD.

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Request an Appointment

Client Full Name

Name of person completing this form

Your relationship to client

Client Gender

Client Date of Birth

Client's Age

Cell Phone #

Current City & State You Reside

Email Address

What insurance do you have? We are only in-network with most Carefirst and Anthem plans.

Main reason for seeking therapy

Please provide any relevant details regarding why you are currently seeking therapy

Choose which services you are interested in.

Individual Therapy

Psychiatry

Psychological Testing (up to age 21)

Postpartum Support Group (insurance not accepted)

EMDR

Parent/Child Consultation (insurance not accepted)

Adult Consultation (insurance not accepted)

Brainspotting

What is your weekday availability for ongoing therapy sessions? Requests for evening appointments will result in longer wait times.

Weekday 7AM-9AM

Weekday 9AM-5PM

Weekday 5PM-8PM

Child: Earliest availability for after school appointments

How did you hear about us?

Name of referring provider:

Are you interested in telehealth sessions, in-person sessions, or both OK? In-person will genally result in longer wait times than telehealth.

Can we leave a detailed message on the phone number listed above?

Which office location do you prefer for in-person sessions?

Today's Date

Thanks for submitting! Please be on the lookout for an email from info@thinkhappylivehealthy.com within 24 hours. Please feel free to follow up with an email.

256 N. Washington St., Suite 2
Falls Church, VA 22046

NEW LOCATION
20955 Professional Plaza
Suite 310/320
Ashburn, VA 20147

703-942-9745

info@thinkhappylivehealthy.com

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