Request a Consultation | Alexandra Miller, LCSW

Consultations

First name

Last name

Phone

Format the number as 999-999-9999

Please ensure that this is an active email address that you have access to. This is how I will be submit the consultation conformation and access information.

Insurance Provider

Please enter the name of your Insurance Provider and if it is a managed Medicaid or Medicare plan. Please do not enter any specific policy information or ID numbers.

Requested Date/Time & Additional Information (If Any)

Please enter two or three dates/times that you would be available for the consultation call. You can also add any additional information you would like me to be aware of. Consultations calls can be scheduled any day, Monday through Saturday from 10:00 AM to 9:45 PM. Please note: Request submission for a consultation does not mean that the consultation will occur at the preferred date and time. All consultations will be responded to and confirmed in the order that they are recieved.

I understand that this form is not intended for emergencies, the website is not consistently monitored, and my requested consultation time is not confirmed until I receive a response.