Become a Client/Contact Us Please enable JavaScript in your browser to complete this form.Name of Perspective Client or Person Seeking Info *FirstLastAge of prospective client *Accepting new clients age 14 and up.New Clients please check all current available times/locations combinations that you are able to get services at: *Mondays 8AM-4PM Columbus In-personWednesday 8AM-12PM Columbus In-personSaturday 8AM-12PM Columbus In-personMonday 7AM-8PM Homeworth Office In-person (2.5 hours from Columbus)Tuesday 8AM-7PM OnlineWednesday 9AM-7PM OnlineThursday 12PM-5PM OnlineSunday 1PM-6PM OnlineOnline Session at all other timesOnline Coaching Sessions- Various Days/Times Available (US residents only)Need Other Info- Contacting CAASS for other information (e.g., client records, consultation, speaking requests)/anything other than becoming new clientEmail *Phone number *What services are you interested in? *Choose an option belowAutism Assessment (can attend at least 6 sessions)Mental Health CounselingCoaching ServicesSpeaking/Continuing Ed InquiryMental Health/ Medical Providers ONLY: ConsultationRECORDS REQUEST- I am a current/former client needing recordsALL OTHER INQUIRES Check here for if contacting CAASS for anything not listed aboveHow will you pay for services/what health insurance company do you have? CAASS offers a significantly discounted self-pay rate. *Choose an option belowSELF-PAY (rate is discounted $100 to $140 per session from $175 depending on clinician)MEDICAL MUTUAL Insurance In-network (not in-network with any Marketplace-healthcare.gov plan or State of Ohio Employee Plan)OHIO HEALTH/Ohio Healthy Insurance In-networkANTHEM*BLUE CROSS/BLUE SHIELD*CARESOURCE*Health insurance company not listed above; will SELF-PAY. Cost reimbursement from health insurance may be possible if have out of network benefits. Self-pay cost: rate is discounted to $140 per session from $175FOR HOMEWORTH OFFICE ONLY-we will contact you with other insurances accepted at only this officeCOACHING Self Pay (Cost $70-$120 per session depending on provider)Contacting CAASS for other information*In-network services provided by clinical partner HMT LTD. List City and State Proposed Client Lives In *What do you need/what challenges would you like help with? *PLEASE don’t send sensitive personal or clinical information via this form.Name of Person Filling Out This Form (only if different from above)FirstLast What is the main way you found out about CAASS? Word of Mouth/Personal ReferralCAASS websiteWeb SearchPsychology TodayAnother Mental/Medical Health PractionerRead an article/YouTube VideoOtherNot Sure/Prefer Not to AnswerNameSubmit