Healing Starts Here.

Name

First Name

Last Name

Email

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How would you like to be contacted to schedule our consultation?

Who is your insurance provider?

Is there anything you would like to share with me beforehand?

Please do not include Personal Health Information in this form.

How did you find me?

I understand that therapy can feel like a big step. That’s why I offer a free, 15-minute Zoom consultation - to answer your questions and help you determine if I’m the right therapist for you.

Hours of Operation: Monday to Friday, 8am to 4pm