Clinical Services Inquiry Form

Thank you for your interest in individual, couple, or family therapy with Nancy Knudsen, LMFT. Please fill out the form below to be added to a waiting list, receive a list of referrals, and/or discuss your therapy questions with Nancy. For questions, email admin@coupleandfamilyinstitute.com.

Name:*

First Last

Phone:*

Email:*

I'm looking for:*

Individual Therapy
Couples Therapy
Family Therapy

For information about couple therapy intensives (1-day, 2-day or 2-day-plus) and to contact us for availability, please visit our Couple Therapy Intensive page.

Please describe any details you want us to know:

Please note that Nancy does not take insurance for couples therapy. For individual and family therapy, she accepts Blue Cross/Blue Shield, United Behavioral Health, Tufts, and Harvard Pilgrim. Her out-of-pocket rates are $175/hr for couples and family therapy, $150/hr for individual therapy, with some sliding scale fees available as needed.

I'd like to:*

Be added to a waiting list
Receive a list of referrals
Discuss a few therapy questions with Nancy

Nancy's work times are Monday-Thursday 12-7pm ET.

What days and times are generally open for you to receive therapy?*

What are your questions?*

Additional questions/comments: