Request Therapy Appointment - Inclusive Wellness Psychology

*Please note that this is not a secure form of communication and sensitive or urgent information should not be included in the content of this message. The information provided will be sent to Dr. Rabideau’s practice email address and will be reviewed.

NOTIFICATION OF PRIVACY RISK: Please be advised that email transmissions are capable of being intercepted, so any confidential information that is sent or received cannot have its privacy guaranteed. By requesting an emailed response to your medical inquiry, you are acknowledging that you are aware of the risks to your (or your patient's) privacy and indicating that you will take responsibility for any related consequences (Electronic Communications Privacy Act, 18 U.S.C.§§ 2510-2521)."

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Primary Insurance Company

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Co-Pay or Deductible Amount per Appointment

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