All information that you provide us is completely confidential and secure. If you would prefer to do the initial contact over the phone, you can call 734.973.6779 and one of our staff members will take your information. Our phone hours are Monday – Friday, 9 am – 5 pm.

  • New Client Intake

    Room to Talk currently accepts the following insurances: Medicare, Blue Care Network of Michigan, Blue Cross Blue Shield, Blue Cross Complete, and Meridian. You may also pay fee out-of-pocket. A third option is Soundings, our sliding-fee program, where clients pay what they can afford for therapy with graduate-student interns.
  • Contact information

  • Emergency Contact

    The emergency contact will only be reached in the following circumstances: we are unable to reach you by any of your provided means, we are concerned for your safety, or you experience a medical emergency while at our facility.
  • Insurance Information

  • Primary Insurance

  • (NOT Group ID#. Typically starts with letters, e.g. ZYX000123456)
  • Secondary Insurance (if applicable)

  • (NOT Group ID#. Typically starts with letters, e.g. ZYX000123456)
  • Sliding-Scale Information

    If you do NOT want to use insurance and would rather pay a sliding-scale fee please fill out the following two questions.
  • Other Information