This is a page to test the YCC Zoho Form Here is the Zoho form. YCC Website Inquiry Client Intake Status -None- New Inquiry Therapist Availability Sent Insurance Information Received Billing Confirmed Consultation Booked Session/Intake Booked Therapist Scheduled Waitlist Referred Elsewhere Active Client Returning Client Closed — No Response Closed — Not Moving Forward Entity -None- Yellow Chair Collective Nabi New Client Name * Pronouns Email * Phone Number * Residency State * -None- CA OR WA NY NJ Other Service Location * -None- Manhattan Beach Office Arcadia Office Burbank Office Irvine Office Telehealth Name of Primary Insurance Plan and Any Additional * Tell us about why you're here Type of Service * -None- Individual therapy Couples therapy Family therapy Child/Teen therapy ADHD coaching Life coaching Preferred Therapist (1) -None- Emma Phan Sakthi Ramesh Sarah Nam Esther Inwoo Kim Emma Lin David Yim Phuong Tang Eliza Yoon Renner Esther Lee Cynthia Mao Dalena Thai Jacqueline Guan Fariah Nur Hart Ruth Sze Kony Das Mina Yoon Jessica Chiu Razdeep Kaur Barbara Hong Solji Kim Alice Chien Jen Gold Catherine Vu Jack Lam Celia Chen Sonia Parecaden Joanna Chang Suzanne Eng Hans Zhang Dana LePage Linda Yoon Soo Jin Lee Nicole Lai No preference – please help me find the best match Preferred Therapist (2) -None- Emma Phan Sakthi Ramesh Sarah Nam Esther Inwoo Kim Emma Lin David Yim Phuong Tang Eliza Yoon Renner Esther Lee Cynthia Mao Dalena Thai Jacqueline Guan Fariah Nur Hart Ruth Sze Kony Das Mina Yoon Jessica Chiu Razdeep Kaur Barbara Hong Solji Kim Alice Chien Jen Gold Catherine Vu Jack Lam Celia Chen Sonia Parecaden Joanna Chang Suzanne Eng Hans Zhang Dana LePage Linda Yoon Soo Jin Lee Nicole Lai No preference – please help me find the best match Preferred Therapist (3) -None- Emma Phan Sakthi Ramesh Sarah Nam Esther Inwoo Kim Emma Lin David Yim Phuong Tang Eliza Yoon Renner Esther Lee Cynthia Mao Dalena Thai Jacqueline Guan Fariah Nur Hart Ruth Sze Kony Das Mina Yoon Jessica Chiu Razdeep Kaur Barbara Hong Solji Kim Alice Chien Jen Gold Catherine Vu Jack Lam Celia Chen Sonia Parecaden Joanna Chang Suzanne Eng Hans Zhang Dana LePage Linda Yoon Soo Jin Lee Nicole Lai No preference – please help me find the best match Specialties / Modalities -None- EMDR ADHD PTSD Grief LGBTQIA+ Other (specify in notes) N/A Referred By -None- YCC Website Nabi Website Psychology Today Google Google Voice Instagram Reddit TikTok Facebook Inclusive Therapists Open Path Entwine Lyra Cigna (insurance directory) Aetna (insurance directory) Optum / UHC (insurance directory) Anthem (insurance directory) Friend / Family referral Previous client Therapist referral Provider referral (PCP / psychiatrist) Newsletter Book (Where I Belong) Care Solace Other Referred By (Detail) Newsletter Opt In
