Connect Now

Questions?
Email: hello@activvcounseling.com
Phone: (703) 966-5173

Whether you are ready to take the next steps or seeking clarification, use our contact form to get connected with us.
Filling out this form is not a commitment, it only begins the conversation. You can expect us to reach out to you within 24 - 48 hours of submission of this form. If you prefer, feel free to call us directly!

We look forward to connecting with you soon!

Let’s get started.

This short questionnaire helps us understand what you’re looking for and connect you with the right scheduling options.

Step 1 of 10

Who are you completing this form for?

This helps us collect the appropriate contact information.

Your information

Please provide the best way for us to contact you.

Your information

Client information

What services are you interested in?

Select all that apply.

A little more about the client

This information helps us determine appropriate scheduling options.

Second partner

Please provide the second partner’s information.

How would you like to meet?

Select all that work for you.

Which in-person locations work for you?

Select all that you would consider.

Do you have a location preference?

You can give multiple options the same priority if you would be equally comfortable with them.

Choose a priority number for each option. 1 = highest priority. Ties are allowed.

Do you have a therapist preference?

Let us know whether you prefer a female therapist, a male therapist, a specific therapist, or have no preference.

Available therapists

Do you plan to use insurance?

This helps us determine the appropriate scheduling and billing information.

Which insurance plan do you have?

Want us to verify your eligibility?
Please email the front and back of your insurance card to so our team can verify your benefits.

When are you generally available?

Select the days and times that usually work for you. You don't need to be exact—we'll use this to help match you with available openings.

Day
Morning
8 AM–12 PM
Afternoon
12–4 PM
Evening
4–7 PM
Late evening
7–9 PM

What brings you here?

Share as much or as little as you're comfortable sharing. This is optional and does not need to include detailed clinical information.

How did you hear about us? *

This helps us understand how people find our practice.

Before submitting:
Please do not use this form for emergencies or urgent safety concerns. If you are experiencing an emergency, contact emergency services or an appropriate crisis resource.

Thank you.

We've received your information. Our team will review your request and follow up with you.