Three Easy Ways to Make an Appointment Request Below 619-600-0683 619-607-1230 Request an Appointment Step 1 of 14 7% I am looking for...* Autism/RDI® Therapy Mental Health Therapy Diagnosis & Testing (including IEEs, re-evaluations and autism diagnosis for all ages) Are you thinking of harming yourself or are you concerned about immediate self-harm for your child?* No Yes Your safety is important to us. Call 911 or Psychiatric Emergency Response Team of SD 619-531-2000 What is your availability for appointments? Select All Early morning 8am-10am Mid-morning 10am-1pm Afternoon 1pm-5pm Evening after 5pm Select All Monday Tuesday Wednesday Thursday Friday Saturday Please enter any times your are NOT available Where would you like services? Home Clinic Community Site through Family Guidance and Therapy Community setting such as preschool, day care, after-school care How will you be paying?* Self Pay Insurance School District Funding How will you be paying?* Self Pay Insurance We take cash, check, Visa and Mastercard, which ever is most convenient to you. We can either collect fees the same day you are in therapy or you can be automatically billed at the end of the month via your credit card. Would you like to submit your insurance information now?* Yes, I will submit the info now I don't want to submit any additional insurance information at this time.. Please call me for the remaining information Choose your Insurance Provider*PartnershipOptumCHGKaiser (only accepted at our Petaluma location)Medi-calI don't use any of these insurancesSecondary InsurancePartnershipOptumCHGKaiser (only accepted at our Petaluma location)Medi-calI don't want to list a secondary insuranceSection BreakIf you don’t see your insurance company on the list, but would like to use your insurance to cover counseling, we also take most PPO plans. Would you like to submit information for your out of network plan?* Yes No Policy Holder InformationName of insurance companyInsurance carrier contact numberDate of BirthAddress of Policy HolderMember IDPlan TypeSubscriber Name Choose your Insurance Provider*PartnershipOptumCHGKaiser (only accepted at our Petaluma location)Medi-calI don't use any of these insurancesSecondary InsurancePartnershipOptumCHGKaiser (only accepted at our Petaluma location)Medi-calI don't want to list a secondary insuranceSection BreakIf you don’t see your insurance company on the list, but would like to use your insurance to cover counseling, we also take most PPO plans. Would you like to submit information for your out of network plan?* Yes No Policy Holder InformationName of insurance companyInsurance carrier contact numberDate of BirthAddress of Policy HolderMember IDPlan TypeSubscriber Name Choose your Insurance Provider*AetnaAnthem BlueCrossBlueCross/Blueshield (Magellan)TricareUnited Behavioral HealthCignaTriwestCeridianBluecross Blueshield of CAUnited HealthCare MagellanI don't use any of these insurancesSecondary InsuranceAetnaAnthem BlueCrossBlueCross/Blueshield (Magellan)TricareUnited Behavioral HealthCignaTriwestCeridianBluecross Blueshield of CAUnited HealthCare MagellanI don't want to list a secondary insuranceSection BreakIf you don’t see your insurance company on the list, but would like to use your insurance to cover counseling, we also take most PPO plans. Would you like to submit information for your out of network plan?* Yes No Policy Holder InformationName of insurance companyInsurance carrier contact numberDate of BirthAddress of Policy HolderMember IDPlan TypeSubscriber Name Is your child a consumer of CA Regional Center?* Yes No Which Regional Center are they with?Consumer DOB and nameService Coordinator name Which location do you prefer?* Point Loma, San Diego Hillcrest, San Diego Tustin, CA Temecula, CA Petaluma, CA Bend, OR Online Request new service area Where are you located? How can we help?* RDI® Therapy Autism Therapy Autism Community Programs Educational Services Occuaptional Therapy Other I Don't Know How can we help?* Individual Therapy Family Therapy Couples Therapy Other I Don't Know If you like please tell us a little more: Name* First Email* Phone*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Method of Contact?* Phone Call Email Text Message 30969 Too Much to Type? Call us at 619-600-0683
