Waitlist | Kiana Wiley, LMFT

Therapy Waiting List

This form will be used to assess fit, your needs, and ensure those interested are attended to when openings arise. Being on the waitlist does not guarentee immediate care.

First name

Last name

Email

Phone number

Age of client

Individual or Family Therapy

Individual Therapy

Family Therapy

Both

Other

What state do you live in?

What are you hoping to work on?

Please provide as much detail as possible to help us respond effectively to your inquiry.

Choose One

Self Pay (Starting at $150/session)

Sliding Scale ($40-80/session)

Out of Network Benefits

Other

What date and time works for you? (Between Monday and Tuesday 10am-6pm)

Join Our Waitlist

Our Location

Therapy Waiting List