Name *

First Name

Last Name

Do you prefer in person or virtual sessions? (A combination of both is also available) *

In person options are limited. We will do our best to meet your scheduling needs but virtual options may be offered as a temporary alternative.

In person in Daphne, AL

Virtual (I am located in Alabama)

Combination of both

Insurance/Private Pay *

I have Blue Cross Blue Shield Insurance

I need private pay information

Are you seeking individual therapy or couples therapy? *

Individual

Couples (booking for March)

How did you hear about us?

Psychology Today

Google

Facebook

Instagram

Other

After completing this form, you will be contacted by Daylight Therapy within 48 business hours. Please be on the lookout for an email from our team with the subject line "Daylight Therapy Inquiry." *

Yes, I understand I will be contacted by email shortly

Please schedule a time to call me also

Please send me a text message also

Phone

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