Somatic Therapy at Elle Studio + Wellness

Name*

First Last

Email*

Phone #*

Date of Birth*

We ask for your date of birth to help expedite the verification process with insurance companies.

Insurance or Self Pay?*

If your insurance is not listed here, we are out of network. In order to work with us, you would need to be a self-pay client. You can also call your insurance company and inquire about any out of network benefits you might have.

If you have other insurance, please let us know what type you have.

Are you a WI resident?*

WI Resident
Out of State

Please be advised that our therapists can only see clients who reside within the state of Wisconsin.

What day(s) of the week work best for scheduling?*

What time(s) of day works best for scheduling? Please be advised that evening time appointments are limited. Please indicate if you have any daytime flexibility with your weekday schedule. Thank you.*

Before Noon
Between 12-5pm
After 5pm

Do you have a preference between in person or telehealth therapy sessions?*

In person only
Telehealth only
Mix of both
No preference

Are you interested in any other services Elle offers?*

How did you hear about us?*

Other comments*

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Somatic Therapy Inquiry

Interested in somatic therapy? Reach out to us to start the conversation.

Somatic Therapy Intake