Reach Out!

Your mental health will thank you.

Let's Go!

Please fill out the secure form below and you will be contacted within 2 business days.

* Indicates a Required Field

Name of Person Seeking Treatment

Name of Parent/Guardian (if patient is a minor)

Patient's Date of Birth

Email Address

Phone Number

Patient Location
IMPORTANT - If you are located in the US, but not in the one of the states below, we cannot provide treatment

If based in the US, do you have insurance?

Do you have a preference of therapist

What best describes your treatment needs?

Please keep questions brief and limited to administrative matters. If you have multiple questions, please opt for a phone consultation.

How did you hear about us?

Direct Referral From Medical Provider

Other Source

By submitting this form and the information within, you acknowledge and agree that this information is accurate and you are only submitting on behalf of yourself or your legal dependent. By providing your phone number and email address, you allow Beyond Borders CBT, LLC to contact you via phone and/or email to coordinate care and acknowledge that email is not a HIPPA compliant form of communication. Beyond Borders CBT, LLC will not sell, disclose, or otherwise use this information for any other reason than coordinating care directly with you.