Moonstone Counseling PLLC Send Message

Who would be receiving care?

Your info

Select the state you live in
Sharing is optional. We’ll use the pronouns you list when communicating with you.
Reason for care
We are unable to take insurance for couples counseling, but can provide a sliding scale rate of $125/session.
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Administrative
Please note: we cannot share personal information via text and will need to email you or message you through the Simple Practice Portal.
Billing & Payment
How do you plan to pay? Providing insurance details now helps us verify coverage in advance but is optional. We are In Network with: BCBS PPO, United Healthcare/Optum/UMR, Aetna, Baylor Scott and White, Traditional Medicare, Some Medicare Advantage Plans, Curative, Sendero. We are no longer in network with Cigna.
Please put N/A if you do not plan to use insurance. Please make sure to include which type of insurance it is, for example BCBS or Aetna.
Upload a photo of your insurance card
We only need this if you would like us to verify or use your insurance benefits.
We only need this if you would like us to verify or use your insurance benefits.
We only need this if you would like us to verify or use your insurance benefits.
We will only use this information for insurance claims filing and benefits verification checks. We will make sure your gender identity is respected.
Limited to 600 characters
Client Preferences
For example: what you'd like to focus on, insurance or payment questions, etc.
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If the clinician you choose does not have availability, we will reach out with some additional options.

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.