Tiffany Mack

(she/her)

Grow Verified

1Select a day and time for your virtual session

It’s free to cancel up to 24 hours before your appointment for any reason.

Relationship to client

Client's legal first name

Client's legal last name

Client's email

Client's mobile phone number

Client's date of birth (mm/dd/yyyy)

Client's sex listed on insurance

Insurance

Insurance name

Member ID

Am I covered?

Check if this provider is in-network and see your estimated cost.

By submitting this form, you agree to Grow Therapy’s Terms of Service and Privacy Policy

Cash, Out-of-pocket

Credit, Debit, or HSA Card

PCI Encryption

Residential address

This should be in the state from which the client will receive care

City

State

Zip code

I have reviewed and accept Grow Therapy's HIPAA Notice of Privacy Practices, Informed Consent, Practice Policies, Terms of Service, and Website Privacy Policy and consent to receive text messages and other communications from Grow about my account and Grow’s services.