First Name

Last Name

Phone Number *

Email Address *

Do you have a mental health diagnosis? *

Yes

No

Are you working with a provider who can confirm your diagnosis?

Yes

No

What type of animal? *

How long have you had your animal? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive informational and promotional text messages from Lola & Me Therapy related to my inquiry.

We cannot accept Medicaid or private pay from clients on Medicaid at this time. We apologize for any inconvenience.