Inquire about talk therapy at Elle where we believe in holistic care.

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?*

Nutrition for Eating Disorder Support
General Nutrition Needs
MindBody Therapy Group for Anxiety
Body Acceptance Group
Grieve & Grow Support Group
Only interested in mental health therapy services.

How did you hear about us?*

Other comments*

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Talk Therapy Inquiry

Please fill out this form to give us a little information about yourself so we can help you in the best way possible. We promise we will never share your information and that we’ll get back to you as soon as possible.

If you are seeking help for an eating disorder, please visit our eating disorder treatment page describing all of our options and fill out the eating disorder inquiry form.

Talk Therapy Intake