Jeri Lea Kroll, LMSW | SimplePractice

Jeri Lea Kroll, LMSW Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Name your child goes by:

Child's date of birth:

Reason for care

What is the reason for seeking care?

Anxiety Attentional difficulties Behavior/emotion regulation issues Depression Grief Parenting stress Attachment or adoption related needs Trauma Other

What kind of care is being sought?

Individual therapy Child/play therapy (child under 12) Safe and Sound Protocol Parent coaching Attachment-focused family therapy (with a child under 12) Not sure

Billing & Payment

Insurance details

I am currently in-network with Aetna, BCBS and BCN. I also can offer a detailed receipt, known as a "super bill", for those looking to submit for possible reimbursement with other insurance plans. And I do have reduced fee slots available on a limited basis through Open Path Collective.

Client Preferences

Preferred appointment times

Morning Afternoon Evening Saturday

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

Limited to 600 characters

Preferred location

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.