Please Schedule Me Form Please Schedule Me Name * First Last * Last Email * Phone * Preferred method of contact * TextPhoneEmail TimePref * Legal * I live in Michigan and am at least 21 years old. You must check this box. Insurance * I understand that eCC does not accept insurance directly or interact with insurance companies as that can potentially inhibit the therapeutic process. You must check this box. Payment * I agree to pay for each session at the start of that session. You must check this box. Abuse/Addiction * I confirm that I am not experiencing abuse issues or addiction issues. You must check this box. Counsel/Therapy * I confirm that I am not under legal counsel and am not being treated by a psychiatrist or other therapist. You must check this box. If you are human, leave this field blank. Submit
