Blooming Expressions Therapy, LLC

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

Administrative

Referral source

Enter how you were referred to our services

Do you prefer to have sessions In-Person or via Telehealth?

PLEASE NOTE: A few clinicians on our team are exclusively telehealth. Our therapists can see anyone across Pennsylvania via telehealth, but our Office is located in Murrysville, PA.

Telehealth Only In-Person Only Either/Both

Billing & Payment

Please indicate your preferred payment method. We will check your coverage prior to any billable appointments.

*If your assigned therapist cannot take your insurance. we are happy to provide Superbills that you can send to your Insurance Company for potential Out of Network (OON) reimbursement. Please Note: OON coverage varies per plan.

Insurance card upload

Upload a photo of your insurance card

Client Preferences

What is your preferred appointment days/times?

Preferred clinician

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Is there any additional information and/or questions you have for us?

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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.