Contact Us Name * First Name Last Name Pronouns Age/Date of Birth Email * Phone Number * (###) ### #### Preferred Contact Method Phone Call Text Email How did you hear about Three Oaks? Google Social Media Word of Mouth School/University Current Client or Employee Psychology Today Flyer/Business Card Other Which sessions are you interested in attending? * Virtual In-person (North Durham office) Insurance * We do NOT currently accept Blue Home, Blue Value, United, Medicaid or Medicare. We are in-network with BCBS (PPO plans), Evernorth (formerly Cigna), & Aetna. We also accept the NC State Health Plan and EAPs. Additionally, we are able to bill out-of-network with other major insurance companies. Please visit our FAQ page to learn more about billing & insurance. Blue Cross Blue Shield Evernorth (formerly Cigna) Aetna EAP Other/Out-of-Network Self-pay Have you been in therapy before? * Yes No Have you participated in DBT therapy before? * Yes No Presenting Symptoms and/or Concerns Suicide Ideation Self-Harm Behavior (cutting/burning/hitting yourself, pulling out hair, scratching/skin picking) Destroying Property Substance Use/Addiction Ineffective Avoidance History of Suicide Attempts Binge Eating/Purging Verbally or Physically Lashing Out Isolation Procrastination Message Thank you! We have received your request. You should hear back within 3 business days.
