Become a new client

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If you are a provider looking to make a referral, please use this form instead

Name

First Name

Last Name

Date Of Birth

YYYY

Phone

(###)

###

####

Health Insurance

If you are hoping to use medical insurance to cover the cost of therapy, please provide the name of your insurance company, or specify that you would prefer private pay

How did you hear about me?

What state are you physically located in?

Birch Grove is licensed in the following states: VT, NY, NH, ME, CT, MI, FL

Location Preference

Telehealth

In Person in South Burlington VT

What days and times are you available to attend appointments?

Appointments are typically available Tuesday through Thursday from 9am to 3pm

Briefly, what are you hoping to address in therapy?

Please do not use this form in the event of an emergency. If you are experiencing a crisis, call 911 or your local crisis team. Information provided via this form may not be secure.

Become a new client

Please complete this form to get started!

Birch Grove Therapy

Online therapy in Vermont, New York, New Hampshire, Maine, Connecticut, Michigan and Florida, specializing in perinatal mental health and helping professionals.