Get To Know Kindred
About Kindred Psychology
Clinicians & Staff
Services
Overview
Gender and Sexuality
Adult Individual Therapy
Adolescent Individual Therapy
Relationship Therapy
Group Therapy Services
Gender Diverse Group Series
Psychological Evaluations
Location and Contact Info
Notice of Privacy Practices
Getting Started
Our Intake Process
Frequently Asked Questions
Submit a Request
The Kindred Community
Join the Kindred Community!
Community Group
Gender Diverse Group Series
Kindred Voices
Resources
Connect
Get Help Now
Location & Contact Info
Request Our Services
Pay My Bill
Client Portal
Community & Advocacy Updates
Psychotherapy Group for TGD Adults – Registration Page
Email
This field is for validation purposes and should be left unchanged.
Full Name
(Required)
First
Last
Legal Name
If your legal name is different than the one you use, please enter it here. This is only for insurance purposes.
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Pronouns
(Required)
Email
(Required)
Enter Email
Confirm Email
Phone
(Required)
May we leave a voicemail at this number?
(Required)
Yes
No
Will you be self-pay or using insurance benefits?
(Required)
I will be self-pay
I will use insurance
Who is your insurance provider?
(Required)
Ex: BCBS, Midland's, UHC, Medicaid. If we do not have your insurance on file already, please be prepared to share your card for eligibility & benefits verification.
Do you currently have an individual therapist?
(Required)
Yes
No
Therapist's name
(Required)
Therapist's contact information (phone or email)
(Required)
Two-Way Authorization of Mental Health Information
(Required)
By selecting the button below, I consent to the exchange of mental health information between group facilitators and my individual therapist for the purpose of continuity of care. I understand that I can revoke this authorization at any time in writing.
I agree to the exchange of information
What do you hope to learn or gain from this group?
(Required)
