Before Your Register for Services

In consideration of an intake for services, you will be asked to provide personal and health information, which will remain confidential. You will also be asked to provide insurance information and/or payment information.

If you would like to proceed, press “continue”

Type of Service Requested:

1.         Individual Therapy

2.         Couple’s Therapy

3.         Clinical Supervision

4.         Career Coaching

How did you hear about EW LifeWorks?

·       Referral from another medical/service provider

·       Website

·       In-network Health Insurance

·       Social media

·       Commercial advertising

·       Collegial or personal relationship with the provider

If response is “collegial or personal relationship” and service options 1 or 2 were selected, the following notice should populate:

Due to the potential for a conflict of interest, it is not advisable to begin therapy with a provider with whom there is/was a collegial or personal relationship with the provider. You are encouraged to seek services with another provider.