Let’s Chat

Fill out this form to schedule a free 20 minute consultation call.

During our consultation call I can answer any questions you have regarding services and ensure I am the right therapist for your therapy goals. If during our consultation call we decide to work together, we can schedule your first session.

You can also send me an email at:
info@therapywithsamira.com

Name

First Name

Last Name

Phone

(###)

###

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What brings you to therapy at this time?

How did you find me? (Google, Psychology Today, referred by someone, etc)

Insurance and Fees

I understand this practice is only in network with Aetna. This practice is considered "Out of Network" with all other insurance providers. Sessions are $200 and billed to the individual if "Out of Network." Please select appropriate insurance and payment option.

Location

What state do you reside in?

Let’s Chat

Samira Dewidar, LCSW