Teens: Start Care here

Beginning your healing journey takes courage, and I am here to walk alongside you. Whether you have questions about the therapeutic process or are ready to schedule your first session, your outreach is met with warmth and care. I provide a compassionate, virtual safe space for teens and adults to navigate life's challenges from the comfort of home.

teen clients: caregivers or teens should fill this out to start therapy

Please fill out the form below and Leahanna will reach out within the next 24 - 48 business hours to schedule your intake session. Reminder: if you are in a crisis please dial 911 or 988. This form will not provide an immediate response.

Name of person completing this form on behalf of a minor

Teen Legal Name (for insurance purposes)

Teen birthday

Month

Day

Year

Teen legal guardian name and relationship to teen

Legal Guardian Phone

Legal Guardian Email

Legal Guardian Address

Teen Address (if different from legal guardian)

State of Residence

Preferred Contact Method

Phone

I consent to text communication about logistical related items only

Yes

Guarantor is the person responsible for the medical bill.

Guarantor First Name

Guarantor Last Name

Guarantor Address

Guarantor Birthday

Month

Day

Year

Guarantor Email Address

Guarantor Phone

Guarantor Relationship to Teen

Insurance Verification

Are you the primary policy holder?

Yes

If no, who is the name of policy holder?

Your Birthday (if you are the policy holder)

Your relationship to policy holder (if you are not the policy holder)

Insurance Company Name

Member/Subscriber ID

Group Number

Front of Insurance Card

Back of Insurance Card

Authorization for Release of Information and Assignment of Benefits

I authorize Leahanna McDonald, LCSW to release any medical or billing information necessary to process insurance claims related to this minor's treatment. I request that payments from my insurance company be made directly to Family Transitions Therapy Services, LLC/Leahanna McDonald, LCSW for services provided.

I understand that insurance verification is done as a courtesy. It is my responsibility to know my plan's specific mental health benefits, exclusions, and pre-authorization requirements.

Affirmation of Legal Custody and Authority

I affirm that I possess the sole or joint legal authority required to consent to mental health treatment for this minor. If a court order or divorce decree dictates that joint parental consent is required for medical/mental health care, I certify that all necessary parties have agreed to this treatment.

I agree to provide a copy of the legal custody agreement to Leahanna McDonald, LCSW upon request. I understand that Family Transitions Therapy Services, LLC/Leahanna McDonald, LCSW will not act as a mediator in parental or financial disputes.

Signature

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Virtual Practice States

Indiana
Kentucky
Missouri
Tennessee

Serving Teens 13+ and Adults

Typical Response Times

I strive to respond to all inquiries within 24 to 48 business hours, Tuesday through Friday. Your peace of mind is important to me, and I appreciate your patience.

Scheduling & Booking

Ready to begin? Scheduling for new and existing clients happens exclusively with me directly after you complete your form.

Crisis Resources

This page is not monitored 24/7 and is not intended for mental health emergencies.

Call or Text 988

If you or someone you know is in immediate danger, please visit your local emergency room or call 911.