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What services are you interested in? *

Individual therapy Couples therapy Group therapy Sandtray therapy Trauma therapy Health & wellness coaching I am open to suggestions

Preferred session format *

In-person Telehealth (online) No preference

Select appointment rate *

Insurance

Your fee depends on your insurance plan.

Session rates

$200.00

Offer sliding scales

What brings you in? What is your main goal or concern? *

Are you currently seeing any other mental health provider?

Yes No

Please list any current medications * Include dosage if known. Leave blank if none.

Have you had any serious suicidal thoughts in the last 5 years? *

Yes No

Insurance provider * Our team will verify your benefits and confirm coverage prior to your first appointment.

How did you hear about us?

Referred by a doctor or provider Referred by a friend or family member Psychology Today Google search Insurance directory Social media

CRISIS NOTICE: If you are experiencing an acute crisis, please call 911 or go to your nearest emergency room immediately. Do not use this form in an emergency.

I understand

INSURANCE POLICY: Ji Young Kim, M.A., LPC-S accepts select insurance plans, including BCBS PPO and Aetna PPO. Your copayment and deductible will depend on your specific insurance policy. If you have out-of-network benefits, Ji Young Kim can provide a superbill for reimbursement.

I understand

APPOINTMENT REQUEST: By submitting this form, you are requesting an appointment. Our team will contact you within 2 business days to confirm availability and next steps.

Your information is kept strictly confidential in accordance with HIPAA regulations.

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