Get Started Contact WellSpace: Therapy Services Name * First Name Last Name Email * Phone * (###) ### #### How can we help? * Individual Therapy for Myself Therapy for My Child(ren) Teen Therapy Couples Therapy Family Therapy Medication Management Something Else Preferred type of appointment In-person Telehealth Which location? Yarmouth, ME Portland, ME N/A Days & Times What days and times work best for you to be seen for weekly recurring sessions? Who is your current insurance carrier? * Aetna Anthem Cigna Harvard Pilgrim Maine Community Health Options (MCHO) MaineCare (out-of-network) Medicare (out-of-network) Self-Pay UHC WellSpace@Work I don't see mine listed Do you have a WellSpace@Work benefit? * Yes No I don't know How did you hear about us? Psychology Today Website Family or friend Colleague Primary Care Physician Another therapist I'm a current WellSpace Maine client I'm a former WellSpace client Other Is there anything else you would like us to know? Contact Training Program Name * First Name Last Name Email * Phone (###) ### #### How can we help? (check all that apply) * Note: If applying for a position at WellSpace, please email resume to info@wellspacemaine.com I am a fully licensed therapist (LCSW, LCPC, LMFT) I am a conditionally licensed therapist I am about to graduate from my master's program I am looking to apply to WellSpace's training program I am interested in applying for a position at WellSpace I'm interested in something else What populations do you like to work with? What theoretical orientations or modalities do you prefer or have interest in? Is there anything else you would like us to know? Thank you! Contact WellSpace@Work Name * First Name Last Name Email * Phone (###) ### #### Company/Organization name * Company/Organization size * 0-50, 50-150, 150-250, 250-500, 500-1000, 1000+ Role in company/organization * How can we help? * I'd like to learn more about WellSpace@Work I'd like to utilize services my employer provides through WellSpace@Work I'd like help with something else Is there anything else you would like us to know? Thank you!