Comprehensive Children's Psychology, PLLC

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First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Email address of individual who is in need of services, if age 13 or above:

Please write N/A if child is under 13. Please note that if teen is 13 or over and no email is provided, your inquiry will not be processed.

Reason for care

What is the reason for seeking care?

Anxiety FNSD PANDAS/PANS OCD Tics Hoarding

Please provide a brief description of the concerns you have for your child or yourself.

Limited to 600 characters

Administrative

Please be aware that Dr. Bastien’s services are only offered through her Virtual Office via VideoConferencing.

I have read the above statement

Please also be aware that Dr. Bastien’s services are private pay only and she does not work with any insurance companies. Payment is due at the time of service and you will be provided with a "superbill invoice" to submit for reimbursement from your insurance.

I have read the above statement.

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

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.

Who would be receiving care?

Your info