Contact

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Headway is the preferred way to book an appointment and check insurance. If your plan isn't supported there, complete the form below or call me directly.

Book Through Headway 585-902-0347

Preferred: Book Through Headway

The fastest way to check your insurance and schedule your first appointment is through my Headway profile. If your insurance isn't accepted there, you can still use the form below or call me.

Book Appointment Through Headway View Insurance Options

Please do not use this form for emergencies or crisis situations. Do not include highly sensitive or detailed clinical information. If you are in immediate danger, call 911 or call or text 988.

Contact Information

First name

Last name

Preferred name

Date of birth

Phone

Preferred contact method

Location & Eligibility

State where you are physically located

Age

Who is completing this form

If client is under 18, relationship to client

Appointment Preferences

Preferred days

Preferred times

Flexible with appointment times

Insurance & Payment

Plan to use insurance

Insurance company

Member ID

Group number

Subscriber name

Subscriber date of birth

Relationship to subscriber

Interested in checking insurance through Headway

If insurance is not available through Headway, discuss other options

Private pay

Reason for Contact

What would you like help with? Please provide a brief description.

How did you find me?

I understand that this form is for requesting information or an appointment and is not monitored continuously. I will not use this form for emergencies or crisis situations.