Bolden Therapy & Wellness Send Message

Who would be receiving care?

Your info

For insurance verification
Select the state you live in
Reason for care
911 or 988 Suicide & Crisis Lifeline: Call or text 988 24/7. Free, confidential support for suicide, mental-health, and substance-use crises. 988 Lifeline Crisis Text Line: Text HOME to 741741 for free, 24/7, confidential support via text.
Play Therapy Group, Skills Group (8-11), DBT, Mental Performance, etc.
Administrative
Enter how you were referred to our services
Do not upload sensitive financial information such as credit card information.
Billing & Payment
How do you plan to pay?
Limited to 600 characters
Upload a photo of your insurance card
Client Preferences
Select a clinician from the list
For example: what you'd like to focus on, insurance or payment questions, etc.
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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.