Contact Us

Name *

First

Last

Email *

This is our most rapid method of communication to help serve you as quickly as possible.

Phone Number

Best Days/Times to Reach You

This will help us reach you at convenient times for you.

City of Residence

What brings you to Free Spirit? What type of counseling are you seeking? *

Kindly please briefly describe any situations/mental health concerns involved and if you are seeking individual, couples and/or family therapy.

What is the date of birth of the client(s)? [This is only to help with therapist placement.] *

Our therapists see clients of various age ranges - this only helps with identifying maximum options for you. For family/couples counseling, you can indicate N/A.

OPEN THERAPISTS & Ask the Director

Note: Licensed Residents in Counseling (post Masters degree) & Interns in Counseling (Masters students) are under supervision

Please select your choice from our list (updated in real time): *

*SPECIAL NOTE on RESIDENTS*: Residents are in network with Cigna/Evernorth and these Medicaid plans: Aetna Better Health, Anthem HK+, Molina, Sentara Health Plans (formerly Optima/VA Premier) & United Healthcare Community Plan. If not on these, residents can be seen for a negotiable sliding fee. **= Interns in Counseling are seen free of charge through our Free Spirit Cares non-profit program.

Please Confirm Therapy Format Preference *

Online Therapy
In Person Therapy
Open to Online & In Person Therapy

This is especially helpful for ASK THE DIRECTOR inquiries - thanks!

INSURANCE DETAILS

Insurance Info - Provider Company, Plan Name, Co-Pay (if known) *

If not applicable, please indicate N/A. Provider name, plan & co-pay information helps us identify placement options we would have to serve you.

Insurance ID #

(This can also be called Member ID# or the sponsor ID # for Tricare, etc.); if there is no insurance please type N/A.

YOUR APPOINTMENT AVAILABILITY

Available Days & Times for Ongoing Therapy Appointments *

Please specify the days of the week and times of day you would be available for therapy appointments in general to help us best serve your needs.

Please list any specific therapist(s) or other additional requests here, if applicable.

How did you hear about us?

Thank you very much for reaching out and connecting with Free Spirit.

Address : 3630 George Washington Memorial Hwy Ste. F-1, Yorktown, VA 23693

E-mail : info@freespiritonline.org

Telephone : (757) 204-1866

OPEN THERAPISTS & Ask the Director

INSURANCE DETAILS

YOUR APPOINTMENT AVAILABILITY