Name *

First Name

Last Name

Phone Number *

(###)

###

####

Services *

I'm seeking :

Individual Counseling

Couples Counseling

Group Therapy

Clinical Consultation

A Letter of Support for Gender Affirming Surgery

Ashley Taylor Counseling is private pay, which means we do not take insurance. I understand that I am responsible for contacting my insurance company about potential out-of-network benefits. If your provider does offer reimbursement, would you be interested in a Superbill (itemized receipt) that you can submit? *

Yes

No

How did you hear about Ashley Taylor Counseling, PLLC? *

Inclusive Therapist Directory

Google Search

Referred by a friend or family member

Facebook

Instagram

Other