Interest Form

Intake Interest Form

Ready to start the process? We make it as easy as possible. Please answer the following
questions, and our scheduler will use your answers to streamline the placement process and
get you an appointment as soon as possible. You can expect a callback within 24 hours
(Monday through Friday) after submitting your form.

Don’t want to fill out the form? No problem. You are welcome to give us a call or send an email
instead! 248-480-0115 or scheduling@bhtherapygroup.com.

If not, should we contact you or the client to schedule the first appointment?

Please Contact MePlease Contact Client Listed Below

Do you plan to use insurance?

YesNo / self-payNot sure

What concerns would you like help with? (select all that apply)

Anxiety / StressDepression / Low moodRelationship issuesTrauma / PTSDLife transitionsADHDOCDDivorce or separationParenting challengesGrief / lossChronic illness or health concernsSubstance use concernsSelf-esteem / identity concernsAging

Are you interested in any specific therapy approaches?

DBTTrauma therapyARTCouples therapySubstance use counselingNot sure / open to recommendation

How did you hear about us? If someone referred you to us, we would love to know!

Do you have a specific BHTG therapist in mind? Please let us know here:

Noelle LothamerLisa Zubal-FalinskiChristine LyonCarin GoodrichNicole IdeMarianne Winter-LongClaudio SchwenznerCaroline BartholomewJessica LeuenbergerAshley ReddingCarla Washington-Faye

What days/times are you generally available?

Weekday morningsWeekday afternoonsWeekday eveningsWeekends

Are you looking for in-person or telehealth sessions?

Anything else you would like us to know about your request?

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Beverly Hills Therapy Group

(248) 480-0115
scheduling@bhtherapygroup.com
31815 Southfield Rd #18
Beverly Hills, MI 48025

Phone Hours

MONDAY	9:00 AM	5:00 PM
TUESDAY	9:00 AM	5:00 PM
WEDNESDAY	9:00 AM	5:00 PM
THURSDAY	9:00 AM	5:00 PM
FRIDAY	9:00 AM	5:00 PM

Weekend and evening appointments available