New Client — Haven Psychological Services

Street Address

City, State, Zip

Phone Number

Troy Lea, Ph.D.. Psychologist

Your Custom Text Here

Important Announcement: Changes to Insurance Coverage

As of April 1, 2024, Haven Psychological, LLC will be transitioning its policy regarding insurance coverage. We will no longer be accepting direct insurance payments.

Please Complete the New Client Form

Name

First Name

Last Name

Birthday

Dr. Lea is only seeing adult clients at this time.

YYYY

Phone Number

in which state do you reside

If your state is not listed I am currently unable to provide services

Type of Treatment Being Sought

Individual

Couples

PCIT

Unsure

Preferred Appointment Times

Select all that apply

Morning

Afternoon

Evening

How did you hear about us?

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