Please note that by providing your phone number, you are consenting to an occasional text message notification from MySpectrum LLC pertaining to scheduling or services. You may revoke this consent at any time by replying to text messages with "STOP".
Please provide which state the patient will primarily be in during sessions. Sessions are teletherapy by default. In-person sessions can only be provided at our North Chesterfield, VA location and are dependent on availability.
Select "Other (write-in)" if your city and state are not listed.
If you are using an insurance policy, you are responsible for knowing what mental health coverage that policy provides. If you want to know the cost of your sessions through insurance prior to scheduling or adding payment information to your chart, please contact the number on the back of your insurance card and ask them about your outpatient therapy benefits.
Name of your EAP (ie- ComPsych, Cigna, Anthem, etc.,)
A referral from your EAP to a specific clinician does not guarantee you will be scheduled with that therapist. EAP companies are not regularly aware of our therapist availability and occasionally provide guidance that is contradictory to our practice's scheduling process. Our schedulers will review your inquiry and check our available clinicians' expertise to confirm we have providers who meet your needs. If you wish to inquire about the availability of a specific clinician, please include that at the end of this form.
If you do not know the EAP name, please write your employer's name or the name of the service you believe is paying for sessions.
For couples counseling, both individuals will receive correspondence from our office.
While some MySpectrum clinicians are able to complete disability leave or FMLA paperwork for patients, scheduling with one does not guarantee that they will fulfill this request. The timeline and decision for completing this kind of paperwork will be dependent on the progress and outtakes of regular therapy sessions. Please check the box above to acknowledge this information.
If you are seeking EMDR services, then the clinician(s) available to provide that service will have to review your intake packet and determine that you are eligible before scheduling. This means that we may not be able to schedule you for EMDR services even if a certified therapist is available. Please keep this in mind as you proceed with our intake process.
All of our therapists work different schedules. If you have any inflexible time constraints, please list them above. Fewer time constraints can lead to faster scheduling, so please only note those limitations that don't have room to change.
Please enter the details of your request. A member of our support staff will respond as soon as possible.