Youth and Family Psychotherapy Services (YFPS) Contact Form

Please fill out the form below to tell us more about your child and the types of services you are seeking.

Child's Name*

Child's Age*

Parent/Caregiver Name*

Relationship to Child*

Email*

Phone Number*

If Other, please describe below

Services Interested in (check all that apply)*

Individual/Family Therapy

Multi-Family Dialectical Behavioral Therapy (DBT) Skills Group

Group Therapy for Parents of Anxious Children

New Mom’s Group

Training Site*

I have read the statement below

I understand that Youth and Family Psychotherapy Services is a training site for advanced doctoral students at William James College and clinicians are supervised by licensed clinical psychologists.

Fees for Service*

I have read the statement below

I understand that Youth and Family Psychotherapy Services is not contracted with any insurance companies. Fees for services are as follows: Initial Evaluation $60 (90 minutes); Therapy Appointments $40 (45 minutes). *Please note that if these fees are not feasible for you, we are happy to discuss a different rate.

YFPS Contact Form

Youth and Family Psychotherapy Services (YFPS)

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