Client Interest Form

What brought you here today?

If you don’t hear back from me within 2 business days, please check your spam folder, or email me directly at info@stardustandserotonin.com.

First Name

Last Name

Phone

Do you plan on using health insurance for therapy? (Practice is in network with Horizon BCBS, BCBS PPO Plans, and Aetna).

Which state do you live in?

Are you interested in telehealth or in person appointments?

What is your availability for appointments during the week, between 9:00 AM - 5:00 PM, Monday-Friday? (Appointments are not offered outside of business hours).

Do you identify with any of the following? (Select all that apply).

Neurodivergent adult Parenting neurodivergent kids Parent of young children (1-5) Parent of elementary age children (6-10) Parent of older children (11+) Postpartum parent Expectant parent Trying to conceive Stepparent Co-parent None of these

What's going on?

contact

Rachael Freni, LCSW
856-296-9141
info@stardustandserotonin.com
1101 Kings Highway N, Suite 103, Cherry Hill, NJ
Office Hours: 9:00 am-5:00 pm M-F

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Home
About
Services
Fees
FAQ
Contact

Contact

Stardust and Serotonin, LLC© | Rachael Freni, LCSW
1101 Kings Highway N, Suite 103, Cherry Hill, NJ
info@stardustandserotonin.com | 856-296-9141

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No Surprises Act
You have the right to receive a Good Faith Estimate of what your services may cost.