Contact

Let’s get started.

Ready to the first step toward creating the life + balance you truly want? Fill out this form and we will get back to you within 48 hours. We’ll answer any questions you might have and match you to the right therapist for you based on your information.

We are so glad you are reaching out!

Name

First Name

Last Name

Phone

(###)

###

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Are you interested in working with a particular clinician?

If so, select their name below. If not, select 'none'.

Are you seeking virtual or in-person therapy?

Virtual

In Person

How did you hear about us?

Please select the payment method you would plan to use if we work together.

Please note: Clinical interns do not take insurance

Specialty or Service

What specialty or service are you interested in?

What is your reason for seeking therapy?

Note: Please do not include Personal Health Information in this form.

Do you have any questions for us?

Email

hello@alignwellmoderntherapy.com

office location

Let’s get started.

hello@alignwellmoderntherapy.com

1715 114th Ave SE, Suite 203, Bellevue WA 98004

Alignwell Modern Therapy