Ancestral Realms

Consultation Intake Form 

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Recommended Consultation Times

Consultation Options

For a 30-minute Consultation

Hello, we would like to familiarize you with the process of our practice here at Ancestral Realms...


Appointments are set on an individual basis: Monday through Friday 10AM-5PM.  Our first consultation is typically 1-hour at $180/hr. A longer session is available a a discounted rate if you would like more discussion time.


Meetings and Communications are in-person office visits or long distance via ZOOM. Setting appointments occurs via email, phone or in person. Please keep email and phone messages concise and business oriented.  We apologize there is no text-ability. All personal information is to be shared during our in-person-times together.


We thank you in advance for your respect on this matter. At a time in modern life where quick text/email/phone call are a more common approach we appreciate the additional time you give us to respond to you. Once you work with us, and urgencies occur, we respond promptly.


Payments are made by check, cash or via PayPal.


Insurance receipts for out-of-network reimbursement can be provided; to initiate please provide insurance form and relevant insurance information ahead of time via email.


Cancellations/Rescheduling: For one on one appointments we have a reservation with you and give up other appointment opportunities to accept yours. As time and space is set for you, we practice with a 3 day cancellation or reschedule policy. If you are unable to keep your scheduled appointment, kindly provide notice by calling: 610-513-2757. Business days are Monday through Friday. Rescheduling rates are $75. Missed appointments or late cancellations are full fee: $180-290. True emergencies are most certainly honored and free of charge.


Thank you for taking the time to prepare me to work with you competently. We look forward to meeting and exploring with you how to be of service to you! Once the Registration Form and payment is received, the next step is to set appointment times. We will contact you as soon as we receive all of your information.


Andrea Bosbach Largent, MSW, SFT