Unmasked Minds LLC
Please complete the form to heal with us.
Where are you currently living? (State must match where you will receive services) - You must live in a state where I am licensed at the time of service. If you live outside of Virginia, you may still complete this form but we may contact you about options like referral resources or coaching.
Please note: individual therapy is only available to folks residing in Virginia.
If you plan to use insurance, this helps us prepare before your first session.
Insurance Eligibility Right Now
Virginia | Yes | Accepting insurance
Florida | Yes | Working toward paneling
All other states |No| Not currently available
Example: Blue Cross Blue Shield
Consent and Acknowledgment
By submitting this form, I confirm the information I’ve shared is accurate and complete. I understand that Unmasked Minds LLC will use this information to support scheduling and communication. My information will not be shared outside Unmasked Minds LLC without my permission.
I understand that submitting this form is for intake and scheduling purposes only and does not create a therapist-client relationship. Therapy services begin only after consent is completed and services are confirmed.
If I am experiencing a mental health emergency, I understand that this form is not monitored in real time and I should contact local emergency services or a crisis hotline (211)
Once you click submit, our team will review your information and reach out within 48 business hours.
If you need support sooner or have questions in the meantime, you are welcome to email info@unmaskedmindsllc.org or text 571-709-6455 to connect.
