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Inquiry Tracker
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Date
Client Name *
Phone
Email
State
CA
WA
OR
NY
Service
Individual Therapy
Relationship / Couples Therapy
Sex Therapy – Individual
Sex Therapy – Relationship
WPATH Letter Evaluation
👥 Partner Information
Partner Name
Partner Phone
Partner Email
Referral / Presenting Question
Cigna Insurance
No
Yes
Flow Stage
Initial Contact
Needs Follow Up
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Letter Eval Scheduled
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Clinician Assigned
💳 Cigna Benefits
Benefits checked / verified
📅 Scheduled Date & Time
📋 Paperwork Status
Intake documents sent to client
Documents completed & returned
Reminder sent to client
Close Reason (optional)
— Not specified —
Booked / started elsewhere
Out of network / cost
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Not a clinical fit
Declined / changed mind
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