Sign up for Clinic Services

If you are interested in the clinic for services, more information or to refer someone else, please fill out the form below to help us identify the needs of those seeking services. The Schiele Clinic does not currently accept Insurance but provides services for a low, sliding-scale fee.

Name*

First Last

Email*

Phone*

Do you have Insurance?*

Yes
No
Prefer not to Respond

If yes, who is your Insurance provider?

Mark the statement that is true for you:

I am looking for Psychotherapy that is covered by my insurance
I cannot afford my insurance co-pay for Psychotherapy services
Prefer not to Respond

**Individuals interested in using their Insurance may be referred to another Psychotherapist in the STLPI network.

How did you hear about the Schiele Clinic?

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