We have made information gathering simple for you, and for us. We get our "paperwork" out of the way before you come to meet with us,
so you don't need to fill in forms at the office. This helps us to be (usually) right on time to sit down with you and start listening/talking.

Please give us some information by typing directly into the boxes below. 
It is okay to be brief in your answers, but lengthy is okay, too.
Be sure the insurance information you enter is correct, so that you and we don't have to spend therapy time verifying it.
We are now using the new Switzerland-based ultra-secure email system ProtonMail for receiving your information.
(If state-of-the-art ProtonMail interests you, see more information at the bottom of this page.)

SCHEDULING
There are many clients we would love to work with, but who cannot see us when we can see them.
Thus, scheduling is our first concern before you share information and try to make an appointment with us.

IMPORTANT:
Durham Appointments: Dr. Richard Cooper sees clients in Durham only on Tuesdays.
Dr. Susan Griffith sees clients in Durham only on Wednesdays and Thursdays.
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Graham Appointments: Dr. Richard Cooper sees clients in Graham only on Thursdays.
Dr. Susan Griffith sees clients in Graham only on Tuesdays.
If you cannot meet on one of those days, we cannot work with you.  Thank you for being interested in us, but there is no need to proceed.

ALSO IMPORTANT: Since the majority of our clients meet with us weekly, at the same time each week, we may need to wait for a time slot to open
(e.g., with a current client's "graduation" from therapy or change in their own schedule) before we can schedule you for your preferred time. 
WE TRY HARD TO ACCOMODATE YOU. We do NOT want getting to your regular therapy appointments to be an additional stressor for you.

When you are through typing in your information
in the boxes above,
press the "Submit" button for your information to be
sent securely to us. Thank you.
NOTE: We reply to many inquiries on the Friday after we receive them. However, sometimes we are waiting to see if we can free up a time to offer you or are otherwise engaged. If you have not heard from us, it is okay to contact us again.
Which therapist would you prefer to meet with? Type "Susan Griffith"
or "Richard Cooper"
or "either" in the box below.
At which office would you prefer to meet? Type in the box below
Durham (Durham/Chapel Hill office) OR Graham (Alamance County/Graham office)?
Take out your medical insurance card.  Fill in the information required.
Type in the box below the name of your insurance company.

Type in the box below your insurance number.
Type in the box below your date of birth.
Type below the address that your insurance company uses for you.
When are you able to come to our office for therapy visits (days with time ranges?)
What is the most perfect time of day (for instance, 4:30 pm, 12 noon, etc.) for you to start your sessions with us? Is that for all days, or just one day?
Type below the name that your insurance company uses for you.
Type your full name
Type your email address.
Type your phone number.
Do you receive texts there? (Type Yes or No)
(See Forbes report about Proton Mail, October 31, 2018.)
If you wish, you can open, very quickly, your own free ProtonMail email account and send us your information from that ProtonMail account to our ProtonMail email account. Visit https://protonmail.com
If you do that, or if you choose to send your information to us from your own other email account rather than via this form above, just copy this version of the questions above and paste them into your email, adding your responses, of course. Then email them to easytotalktoforms@protonmail.com
copyright 2018
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