Client Form - Ethera Connect

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Step 1 of 5

Hi, we're so glad you're here. Let's get you matched with the best therapist for you. This won't take long, and it will definitely be well worth the 10ish minutes!

Unfortunately, we are not able to match Medi-Cal clients at this time. Please feel free to check back again next month.
If you're under the age of 18, please use your guardian's contact information.

Now, let's take care of the logistics:

*For those in Southern California, we offer therapist matching for both in-person and teletherapy sessions. Anywhere else in California, we offer therapist matching for teletherapy sessions.
If in-person sessions are preferred, please include the location below.

A Superbill is when the therapist gives you a claim that you can submit to the insurance company for reimbursement (PPO plans only).

*Many therapists may not be able to accommodate an out of pocket rate lower than $100

Don't have any specific preferences?

Go to the bottom of the page and click Next to skip ahead.

Almost there! Tell us a bit more about yourself (you can share as much or as little as you'd like - all information will be anonymized and kept confidential)

*If you're under the age of 18, please use your guardian's contact information.

Step 1 of 5

Hi, we're so glad you're here. Let's get you matched with the best therapist for you. This won't take long, and it will definitely be well worth the 10ish minutes!

*Unfortunately, we are not able to match Medi-Cal clients at this time. Please feel free to check back again next month.*If you're under the age of 18, please use your guardian's contact information.

Now, let's take care of the logistics:

*For those in Southern California, we offer therapist matching for both in-person and teletherapy sessions. Anywhere else in California, we offer therapist matching for teletherapy sessions.If in-person sessions are preferred, please include the location below.

A Superbill is when the therapist gives you a claim that you can submit to the insurance company for reimbursement (PPO plans only).

*Many therapists may not be able to accommodate an out of pocket rate lower than $100

Don't have any specific preferences?

Go to the bottom of the page and click Next to skip ahead.

Almost there! Tell us a bit more about yourself (you can share as much or as little as you'd like - all information will be anonymized and kept confidential)

*If you're under the age of 18, please use your guardian's contact information.

Unfortunately, we are not able to match Medi-Cal clients at this time. Please feel free to check back again next month.
If you're under the age of 18, please use your guardian's contact information.

*For those in Southern California, we offer therapist matching for both in-person and teletherapy sessions. Anywhere else in California, we offer therapist matching for teletherapy sessions.
If in-person sessions are preferred, please include the location below.