Session Type *

I only offer couples therapy. Are you looking for a couples therapist?

Yes

No

Specialty *

My specialty is couples and sexual health. I only offer couples therapy to couples who want to work on their sexual relationship, in addition to their overall relationship. Are you wanting to work on your sexual relationship (in addition to other relationship issues)?

Yes

No

Availability *

My office hours are: - Wednesdays and Thursdays, 12:30pm-5:30pm MST (my last session starts at 4:30pm) - Fridays 10am - 3:30pm MST (my last session starts at 2:30pm). - I reserve Tuesdays for intake assessments and intensives (sessions longer than 45 minutes). Do my office hours work for your schedule?

Yes

No

Schedule *

Sessions are scheduled every other week on the same day and same time. For example, your session might be every other Friday at 2:30pm. Does an every other week, same day/same time session work for your schedule?

Yes, my schedule is flexible

Yes, but I would need a specific day/time

No

Payment *

I do not accept insurance, but I will provide a superbill that you can submit to your insurance for reimbursement. My fees are $440 for the initial 90 minute assessment session, and $220 for every subsequent 45 minute session. Do these fees work for you?

Yes

No

Office Location *

My office is located at 3191 S. Valley Street in Salt Lake City, Utah. If you prefer in-person sessions, does this location work for you? If you prefer video sessions, I am licensed in Utah and over 40 additional states (called "PSYPACT Participating States," listed here : https://psypact.gov/page/psypactmap). I can only work with clients who live in one of the states listed. Do you live in one of those states?

Prefer in-Person: Yes, your office location works for me

Prefer video: Yes, I live in one of the states in which you are licensed.

Either in-person or video: Yes, your office location works for me and I live in a PSYPACT state.

Waitlist *

At this time, my waitlist is around 6 months (which I know is not ideal). Can you wait that long to start couples therapy?

Yes

No

Consent *

I consent for Jordan Rullo, LLC to collect my details through this form.

Yes

No

If you answered YES to all of the above questions, I will contact you within one week to schedule a 10-minute phone consultation. *

Please provide your contact information:

First Name

Last Name

Phone

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