In case of emergency: If you or someone you know is reporting thoughts of suicide, or if someone is behaving in a dangerous or unsafe manner, call or text the Crisis Line at 988, call 911, or go to the nearest emergency room.

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Age

Please indicate your age if you are seeking services, or the age of the person for whom you are inquiring about services.

Reason(s) for Seeking Services

Please provide a brief description of your concerns:

If applicable, please select the therapy/therapies you are specifically seeking: *

Comprehensive Dialectical Behavior Therapy (individual and skills group)

Individual DBT

Multifamily DBT Skills Group (for adolescents who already have an individual therapist)

CBT-E

Other/Not Sure

Please indicate your preferences for services:

I am interested in in-person treatment at your Ruston, WA office.

I am interested in telehealth therapy.

Preferred Contact Method

Please specify if you prefer to be contacted by email or by phone. If you prefer being contacted by phone, please provide the days/times when you can typically be most easily reached, and indicate whether it is okay to leave a voicemail if you do not answer. Please note that it often takes me at least one week to respond to treatment requests by phone:

Please review the disclaimer below and press SUBMIT

I acknowledge that electronic communication, including web forms and e-mail, is limited in terms of privacy and may be intercepted by a third party. I hereby release Dr. LoTempio from any and all liability that may occur due to electronic communication over a non-secure network.

Treatment Inquiry Form

Please note that Dr. LoTempio is not in-network with any insurance plans. Depending on your eligibility, your insurance may reimburse you for a substantial part of the fees for out-of-network services. Please contact your insurance to inquire about your out-of-network coverage and limits.