Appointments Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. of Insurance (to Enter your name *FirstLastPreferred Location *--- Select Choice ---SomersetTelehealthPreferred Therapist--- Select Choice ---Rosenna Pemberton, LPC, PsyA, ACSNadia Ghnaim, MSW, LSWAstrid Christiansen, MSW, LCSWRaazia Ali, MSW, LCSWMarianne Gabrael, MC, LPC, NCCFalasade Harris MA, LACKhadijah Grant, LCSW, CSSWKyra Williams, MS, LACCandice Covington-Thomas, JD, LCSW, CCSRenae Bush, MA, Ed.S, LAC, SACPreferred Gender/Race--- Select Choice ---Male/MinorityMale/Non-MinorityFemale/MinorityFemale/Non-MinorityIf you do not have a preferred therapist, please select your choice aboveTypes of Services--- Select Choice ---Individual TherapyEMDR & Trauma RecoveryCouples TherapyFamily TherapyProfessional DevelopmentInsurance or Self-Pay *--- Select Choice ---AetnaBC/BSCigna/EvernorthEAPMedicareMeritainOscar HealthSelf PayUnited Healthcare/OptumUnited Healthcare/OxfordAvailability (check all that apply)Monday MorningMonday AfternoonMonday EveningTuesday MorningTuesday AfternoonTuesday EveningWednesday MorningWednesday AfternoonWednesday EveningThursday MorningThursday AfternoonThursday EveningFriday MorningFriday AfternoonFriday EveningSaturday MorningSaturday AfternoonSaturday EveningSunday MorningSunday AfternoonSunday EveningPreferred Method of CommunicationEmailPhoneText MessageEnter your Email Address *Insurance Card * Click or drag a file to this area to upload. Upload the front of your insurance card. PDF or photo (JPG, PNG, HEIC). Max 10MB.Insured's Date of Birth (to check Benefits) *Enter your Phone Number *Submit