Cosmic Daisy Counseling PLLC - Caitlin Senger

Who would be receiving care?

Someone else

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Phone

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Administrative

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Billing & Payment

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Insurance details

If you are using Curative Health Plan, please enter your insurance information below and upload clear photos of the front and back of your insurance card. Include the policyholder's name, member ID, and group number (if applicable). If you are paying out of pocket, you can leave this section blank.

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Insurance card upload

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Client Preferences

What type of session(s) are you looking to schedule?

Is there anything you want your therapist to to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.