Please note at this time my current operating hours are Monday - Thursday 9am - 5pm. Are you still interested in moving forward. *

yes

no

Name *

First Name

Last Name

Phone

(###)

###

####

Preferred method of contact *

Email

Phone

Have you done therapy before? *

yes

no

Will you be using health insurance or paying out-of-pocket? *

*Low income services are offered. You will need to provide proof of income at the time of consultation.

Health Insurance

Out-of-pocket