Ready to get started?

Fill out some info below and we will be in touch shortly about next steps, anticipated wait times, etc.

Potential Client Inquiry Form

This is not an intake form or medical history form. This is an administrative form for potential new clients to learn more information & request contact from the office of Beverly Groves Therapy. Filling out this form on its own, does not establish care with either of our providers. Client care will be established within our HIPAA secure client portal Simple Practice. Established clients have access to online booking through our secure client portal. There is not a spot on this form to leave a personal message.

First Name + Last Initial

Please include your first name and last initial.

First Name

Last Name

Please include an email address you feel comfortable with Beverly Groves sending an inquiry response to. This does not sign you up for promotional materials or any newsletters at this time. This does not need to be your primary email or the email you would like to use in the future for services.

Inquiring for services from:

Please choose the clinician you would like to receive more information about.

Lezlee Hays LPC

Grace Shivka LPC

Both

Interested in learning about Insurance?

Choose the provider you have if you would like to learn about using insurance as a form of payment.

Interested in In Person Sessions, or Tele-Health?

Please let us know if you would like an in-person session, tele-health session or if your open to first available. This will help us better anticipate your wait for services and provide you with more accurate potential availability.

Disclaimer:

By submitting this form, you are agreeing to Beverly Groves Therapy contacting you via email from office@beverlygrovestherapy.com within approximately 24-72 business hours. This form alone does not establish care. Beverly Groves Therapy services including this form are not for crisis or emergency care, if this is an emergency call 9-1-1.

ESTABLISHED CLIENT?

Client Portal

Established clients can view our client portal page to schedule sessions using the online portal.

This option is not available for new inquiries but will be set up once care is established with our practice. If you are looking to start services, use the inquiry form.

Ready to get started?

ESTABLISHED CLIENT?

ESTABLISHED CLIENT?

Beverly Groves Therapy

7330 N 16th Street
Phoenix, Arizona 85020

office@beverlygrovestherapy.com
480-274-3863

Important Read: Terms And Conditions
Notice of Privacy Policy Practices
Privacy Policy

© 2024 All Rights Reserved Beverly Groves Therapy

Ready to get started?

ESTABLISHED CLIENT?

ESTABLISHED CLIENT? ESTABLISHED CLIENT?

Beverly Groves Therapy

7330 N 16th StreetPhoenix, Arizona 85020 office@beverlygrovestherapy.com480-274-3863

Important Read: Terms And ConditionsNotice of Privacy Policy PracticesPrivacy Policy

© 2024 All Rights Reserved Beverly Groves Therapy

ESTABLISHED CLIENT?

7330 N 16th Street
Phoenix, Arizona 85020

office@beverlygrovestherapy.com
480-274-3863

Important Read: Terms And Conditions
Notice of Privacy Policy Practices
Privacy Policy