Let’s work together

To start the intake process, please fill out the form below.
Someone from our Administrative Team will get back to you within 2 business days with available appointments.

Radiant Therapy, LLC is in network with Blue Cross/ Blue Shield, Cigna and United Healthcare. *At this time we are NOT accepting new patients with Aetna, Medicaid, EAP, or Tricare insurance.

PLEASE READ FAQ'S BEFORE FILLING OUT FORM BELOW

CLIENT INFORMATION

Name

First Name

Last Name

Date of Birth

YYYY

If Client is under the age of 18

Please put your name and relationship to Client below

Phone

(###)

###

####

Preferred form of contact

CLINICAL INFORMATION

Reason for therapy

Please do not include confidential or sensitive information.

Availability

Location

We offer in person and telehealth appointments

Preferred Therapist

Insurance Carrier

Let’s work together

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