Ready to live life in alignment with who you are?

This form is for individuals seeking therapy services.

Please note that Hope Heals Therapy does not accept insurance. Superbill is provided for reimbursement if you have out-of-network benefits. Find details about fees here

Therapists interested in EMDR consultation for certification, CIT, or case consultation may click here.

Request for free 15-Minute initial consultation

Name

Email

Phone

How did you find out about us? How did you find out about us? Referred by a friend Referred by a provider Returning client Online search

Where are you located? Where are you located? Texas Washington State Florida

Please describe the concerns that bring you to therapy (be specific) and what you are looking for in treatment or in a provider.

Please acknowledge the following (Please check both boxes) Please acknowledge the following (Please check both boxes) I am aware that Anusree Gupta provides services virtually through video only. In-person sessions are not available.

I am aware that Anusree Gupta does not directly participate with insurance, that I will be paying the full fee at the time of service, and I can choose to submit claims to my insurance for out-of-network reimbursement.

13 + 3 =

Response Time

Emails are responded to between 9am to 5pm Monday-Friday within 24 to 48 hours of receiving the emails.

Emails and Calls received during weekends and holidays are responded to during the next 1-2 regular business days.