BeWELL Psychotherapy Contact Form

Contact Information
Phone: 646-863-0101
Text: 646-863-0101
Email: contact@bewellpsychotherapy.com

Office Locations

Flatiron, NYC
928 Broadway, Suite 405
New York, NY 10010

Hoboken, NJ
36-42 Newark Street, Suite 201
Hoboken, NJ 07030

We’re excited to help you start your wellness journey! This quick 5-minute form gives our Client Care Coordinator the details needed to match you with the right practitioner at BeWELL.

Your time is valuable, and this step ensures we can provide care that fits your needs and schedule.

Let’s get started!

Patient Information

First Name *

Middle Initial

Last Name *

Date of Birth * +

Phone Number *

Email *

Address (City, State, ZIP) *

Pronouns

Insurance Information (If Applicable)

Do you have out-of-network benefits? *

If you plan on using out-of-network benefits, please upload a photo of your insurance card. (FRONT and BACK)

While our client care coordinator works on scheduling you with a BeWELL therapist or

mind-body coach, they will verify your benefits and let you know about your plan.

Appointment Information

Please fill out the questions below so our client care coordinator can match you to the BeWELL practitioner that best fits your needs.

Which service(s) are you interested in? *

Are you interested in virtual sessions, in-person sessions, or a mix of both *

Preferred Practitioner? *

Preferred Day Of Week For Session (choose as many as possible) *

Preferred Session Time (choose as many as possible) *

Morning (8 AM - 12 PM)

Afternoon (12 PM - 4 PM)

Evening (4 PM - 8 PM)

Which of the following are you currently experiencing? *

What brings you to therapy or mind-body coaching at this time? *

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Additional Information

How did you hear about BeWELL Psychotherapy?

A BeWELL Client Care Coordinator will carefully review your responses to ensure the best match with one of our therapists or coaches. You can expect to hear from us within 24-48 business hours to discuss your needs and set up an appointment. We look forward to supporting you on your wellness journey!