Name *

Age *

Email address *

Phone number (Include Country Code) *

Which service or services are you interested in? *

Please select at least one option.

Individual Psychotherapy — from $60

Couples Therapy — $80

Family Therapy — $90

Session Mode *

Please select at least one option.

In-Person

Online (Via Zoom/Google Meet)

Preferred Contact Method *

Preferred Therapist Gender *

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No Preference

Male Therapist

Female Therapist

Select a date and time *

Select a date and time

September 2018

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Morning

Afternoon

Evening

No availability, try another day

How did you hear about us ? *

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A.I Search

Google Search

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Referral

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Confirmation & Consent *

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I confirm that I understand each therapy session at Cognitive Analytica is a paid, professional service. Session fees start at $60 per session and may vary depending on the type of service and therapist. Payment is required before or at the time of each appointment.