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Request a Consultation

I understand that reaching out for help can be a difficult and courageous step. I'm here to support you on your journey towards better mental health and well-being.
 

To take the next step in scheduling a consultation with me, please complete the patient intake form. I look forward to connecting with you.

Patient Intake Form

Contact Information

Insurance Information

Do you currently have insurance?
Yes
No
Insurance Provider

Reason for seeking therapy

Current Symptoms and Concerns

Consultation Request

We look forward to connecting with you. Please provide your preferred date and time for a free 15-minute consultation. Your preferred time and date selected is not guaranteed, but we will do our best to accommodate your schedule.

Preferred Time of Consultation
Time
HoursMinutes
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