Request for a free 20 minute video consultation

Name

Email

Phone

How did you find out about us? How did you find out about us? Referred by a friend Referred by a provider Returning client Online search

Where are you located? Where are you located? Texas Washington State

Please describe the concerns that bring you to therapy (be specific) and what you are looking for in treatment or in a provider.

Please acknowledge the following: Please acknowledge the following: I am aware that Anusree Gupta provides services virtually through video only. In-person sessions are not available. I am aware that Anusree Gupta does not directly participate with insurance, that I will be paying the full fee at the time of service, and that I can choose to submit for Out-of-Network reimbursement through my insurance if I would like. I acknowledge that electronic communication such as this one is limited in terms of privacy and may be intercepted by a third party. I hereby release Anusree Gupta from any and all liability that may occur due to electronic communication over a non-secure network.