The First Step In Your Healing

Schedule your free consultation.

Take the first step toward change with a free consultation. During this 10-minute phone call, we’ll discuss your needs, goals, and any questions you may have about the therapy process.

Get Started

Fill out this form (don’t worry, it’s brief!) and I’ll be in touch within 48 business hours to set up a time to talk.

Please Note

This form is used to request a free 10-minute phone consultation to learn more about telehealth therapy services provided by Chaya Bukiet, LMFT.

The purpose of a phone consultation is to determine whether Chaya Bukiet would be a good fit for your therapy preferences.

Please use this phone consultation as an opportunity to ask Chaya questions about her services, availability, approach and any other questions or concerns.

Please be advised that Chaya Bukiet, LMFT does not provide custody evaluations or recommendations, medication management, legal advice, emotional support animal (ESA) letters, recommendations for service animals or service dog support letters, letters for accommodations of a disability/Schedule "A" letters, workers' compensation or Family and Medical Leave Act (FMLA) letters.

You must live in the states of Florida, Georgia and New York and be at least 18 years of age to be eligible to receive mental health services from Chaya Bukiet, LMFT.

Full Name

Email Address

Date of Birth

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Phone

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I'm interested in:

Individual Therapy

Couples Therapy

Family Therapy

How can we help?

How'd you hear about us?

What is your availability for the 10 minute consultation call?

Please list a few dates and times

Please confirm you understand the following before scheduling the consultation:

I acknowledge that Chaya Bukiet LMFT provides telehealth therapy services only; in-person sessions are not currently available.

I acknowledge that Chaya Bukiet LMFT is only seeing clients during the following days/times: Monday-Thursday 9:15-3:15

I acknowledge that I will be paying out of pocket for therapy services, as Chaya Bukiet, LMFT, does not accept insurance at this time.

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