Step 1 · About you

Please give us your information

So we can reach you about your consultation.

First name

Please enter your first name.

Last name

Please enter your last name.

Mobile phone

Please enter a 10-digit phone number.

By continuing, you consent to receive text messages and/or emails from Inner Balance Counseling. Msg & data rates may apply. Message frequency varies. Reply STOP to opt out.

Please check the fields above.

Step 2 · Your visit

Are you a new or existing patient?

This just helps us prepare for your call.

Step 3 · Stay in touch

Where should we send your confirmation?

We'll email your appointment details and a reminder.

Please enter a valid email address.

Step 4 · Insurance

Verify your insurance eligibility

Share your insurance now and our team can check your coverage before we call, so you can be cleared for care sooner.

Date of birth

Please enter your date of birth (MM/DD/YYYY).

Required to set up your patient chart.

Insurance

Please choose your insurance, or Self-pay.

We do not accept EAP plans.

Insurance card photos (optional)

or type it in

Member / policy ID (optional)

Is the plan in your name?

Whose plan is it?

Policyholder’s full name

Policyholder’s date of birth

Insurers need the policyholder’s name and date of birth to find the plan.

Why we ask: it's for your benefit. With your insurance up front we can verify your eligibility much quicker. We only use it to check your coverage, and it stays private. No card handy? Leave the card part blank and continue.

Step 4 · Pick a time

Pick a time for your 15-minute call

Emm, our Client Care Coordinator, will call you at the time you pick.

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SMTWTFS

Choose a date

Please pick a time to continue.

Review

Does everything look right?

Emm will call you at this time to talk through what you're looking for and match you with the right therapist.

Something went wrong. Please try again.

Your consultation is booked

Emm, our Client Care Coordinator, will reach out at the time below.

Need us sooner? Call 602-675-6185

Cancel

Cancel this consultation?

Cancellations are handled by our team. We'll send them your request and someone will confirm with you. Please note our policy: appointments cancelled with less than 24 hours' notice may be charged a $125 late-cancellation fee.

Tell us why (optional, but it helps):

Anything else?

Please choose a reason.

Your consultation is cancelled

No problem — you can pick another time whenever you're ready.

Questions? Call 602-675-6185

Text us

Send us a message and we'll be in touch

What's your question?

Please type your message.

Text us

Please share your contact details

First name

Please enter your first name.

Last name

Please enter your last name.

Please enter a valid email address.

Mobile phone

Please enter a 10-digit phone number.

By continuing, you consent to receive text messages and/or emails from Inner Balance Counseling. Msg & data rates may apply. Message frequency varies. Reply STOP to opt out.

Please check the fields above.

Thanks!

We got your message. We will be in touch soon.

Need us sooner? Call 602-675-6185