Thank you for your interest in working with Dr. Eva Benmeleh.

This brief form helps us determine whether a clarity call is appropriate and how to make the conversation useful for you. Please note that Dr. Benmeleh is a private-pay provider and does not accept insurance.

By providing your contact details, you agree to receive communications from Dr. Eva Benmeleh. Your information will be handled according to our Privacy Policy, which you can review here.

Full Name

Email *

Phone *

Please share in which State you are a resident.

Where did you find us?

Which type of support are you currently exploring?

I understand that this clarity call may be recorded for training, quality, or training purposes. By submitting this form and attending the call, I consent to being recorded.

I Accept

I don't accept

Financial Transparency Dr. Benmeleh's work includes: Clarity Intensive (2 week support): $600 USD 1:1 work (3 months): $6,000. Are these ranges workable for you if you decide to move forward?

How soon are you looking to start services?

Have you worked with a therapist, coach, or other practitioner before?

Yes

What feels important for you to gain clarity about through an initial conversation?

Is there anything else you’d like to share before we connect?

Please share anything that will help prepare for our meeting that has not already been asked. This includes questions that you may have for us so that we can better prepare for our call.

I understand that Dr. Benmeleh is a private-pay provider and does not accept insurance. However, she can provide a superbill to submit to your insurance for potential reimbursement.

Yes