TAC Therapy, PC
Home
Re-Branding statement
About
Services
Team
Rates and Insurance
Make a Payment
Appointment or Information Request Form
FAQ
Forms
Blog
Jobs
TAC Therapy, PC
Home
Re-Branding statement
About
Services
Team
Rates and Insurance
Make a Payment
Appointment or Information Request Form
FAQ
Forms
Blog
Jobs
Appointment or Information Request Form
17282 Farmington Rd, Livonia, Michigan, United States
+1-(248)301-0308
tactherapypc@gmail.com
Each therapist sets her own hours but we are typically open Monday through Friday 9am-6pm and Saturday 9am-2pm
First and Last Name (legal)
*
Phone
Email address
*
What insurance will you be using?
Blue Cross Blue Shield (BCBS PPO)
Blue Care Network (BCN HMO) *not all therapists in the office can take this plan
I will be paying out of pocket and would like a fee for service quote
What service are you seeking?
Talk therapy
Pre-surgical weight loss evaluation
Any Requests? (ie: in person appointments, virtual appointments, weekend availability, a therapist who is more direct, a therapist who is more gentle, etc)
How did you find us?
Referred by doctor
Referred by teacher
Friend/family member
Google serach
Psychology Today
Other
Preferred Method of Contact
Email
Phone
Text
If this form is being completed by someone other than the patient, please add your full name and relation to patient
Submit
+1-(248)301-0308
tactherapypc@gmail.com
17282 Farmington Rd, Livonia, Michigan, United States
