Therapy with Andrea Application-Andrea Anderson Polk

Therapy with Andrea Application

Andrea provides private 1-on-1 therapy sessions to women interested in pursuing successful, long-term freedom and fulfillment. She is excited about the prospect of meeting with you and truly appreciates your interest.

To ensure the best results for Andrea's clients, please complete the following application thoroughly and with complete honesty.

Upon receiving your information Andrea will be in touch to advise as to next steps.

First Name

Last Name

Phone Number

Occupation

Client Age

Are you currently receiving therapy? If so, please indicate for what issues and how long.

What is your reason for pursuing therapy with Andrea?

Please explain the specific issues you would like to address in therapy.

What city and state do you currently reside?

Referred to Andrea by:

What is your preference for appointments:

In-person

Virtual

A mix of in-person and virtual

No preference

Would you like to be added to Andrea's newsletter to receive occasional emails with tips, tools, and information? (Unsubscribe at anytime).

Yes, please add me to the list!

No, I do not want to receive any mailings.

Individual psychotherapy sessions are scheduled for 60, 90, or 120 minutes.

60 Minute Individual Session: $220

90 Minute Individual Session: $330

120 Minute Individual Session: $440

Breakthrough Intensive Therapy Sessions: Fee is per therapy hour ($220).

**Speak with Andrea about your unique needs with regards to a one-time Intensive session or for 2+ days.

Telehealth sessions are only available for clients physically located in the state of Virginia.

Payment is due at the time of service. Andrea is an out-of-network provider and does not participate with insurance companies. However, she will provide you with a superbill to submit to your insurance company.

Let Andrea know if you are interested in “Breakthrough Intensive Therapy." Therapy intensives are ideal for someone who is needing short term treatment for long term impact or anyone who is coming from out of town. Additional information HERE.

After we review your application, if it looks like you’d be a good fit for working with Andrea, she will reach out and send you times to have a free 15-minute phone consultation.