The Montfort Group | SimplePractice

Who would be receiving care?

My partner and me

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Reason for care

What brings you to therapy right now?

You can keep it simple. A few sentences about what’s happening or what prompted the search is enough.

Limited to 600 characters

What type of support are you looking for?

If you’re unsure which one best fits, choose what feels closest. We can help you clarify once we connect.

Is there anything from your past mental health history that would be helpful for us to know?

Share only what feels relevant. Prior therapy, diagnoses, or anything that shaped your experience is helpful, but not required.

Limited to 600 characters

Are you currently working with any other mental health providers?

This helps us understand coordination needs.

Yes No

Have you ever worked with someone at The Montfort Group before?

We ask this to ensure continuity or proper reassignment.

Is there anything that has made it hard to start therapy in the past?

Many people have hesitations. Share anything that would help us support you more thoughtfully.

Limited to 600 characters

Administrative

How do you plan to handle payment?

We are an out of network practice. Private pay or out of network reimbursement are both welcome. Choose whatever fits your plan, and we can help you with next steps.

I plan to pay privately I plan to use out of network benefits I’m not sure yet

How did you find The Montfort Group?

This helps us understand how people are connecting with us.

Client Preferences

What days or times generally work best for you?

This helps us match you with therapists who have openings that fit your schedule.

Weekday mornings Weekday afternoons Weekday evenings Weekend Flexible

How would you prefer to meet?

We offer both in person and virtual sessions. Choose whatever feels most comfortable.

In-person Virtual Either is fine

Is there anything else that would help us match you well?

Some clients prefer a certain style or approach. Share anything that matters to you.

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.