Collaborative: EMDR Trauma Therapy Intensives

Your info

First name

Last name

Phone

Date of birth

Reason for care

Because my practice is intensive and highly focused, I work with a limited number of clients at a time. This structure allows for deep and sustained trauma work. If you’d like to be placed on the waitlist for the next available opening, you’re welcome to submit this form and complete the onboarding process.

I understand there is a wait of approximately 4-6 weeks to begin treatment. I do not have urgent mental health needs requiring immediate or emergent attention.

Administrative

Do I have permission to text you from a HIPAA-Secure medical record-keeping software?

Once I have this form, I'll text you with a link to schedule your free, 20-minute phone consultation. We'll use that time to explore your goals, a brief history, and start to determine if this could be the right fit for you.

Billing & Payment

The services I offer are specialized and are not recognized by insurance carriers. I do not offer Superbills for Out of Network reimbursement.

Extended sessions are billed at $225/hr & Intensives are billed at $300/hr. I accept credit cards, FSA and Care Credit (deferred-interest financing)

I understand I will not be able to use insurance to cover any services with Jessica Bennett. I understand I will not receive a Superbill for out-of-network reimbursement.

Client Preferences

I do not offer standard, hour-long sessions. Please check below to indicate which type of session you are interested in.

Weekly or bi-weekly 2-3 hour sessions. A one-time intensive to address a single event. Concierge Packages (limited and by application only).

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.