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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Phone number
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Please enter as XXX-XXX-XXXX
Your answer
What services are you interested in?
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Therapy - individual, couples, family
Coaching
Talks and trainings
Clinical Consultation
Program Planning/Consultation, Strategic Planning, Program Evaluation
Other:
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Subject
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Your answer
Message
*
Your answer
Availability for a brief phone call to follow up
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(on Tuesdays, Wednesdays, or Thursdays, between noon and 8pm)
Your answer
Needs related to payment for psychotherapy
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Please note - I do not take any insurance.
Private Pay - full fee
Private Pay - sliding scale (determined by need and availability)
I am a person of color
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No
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I am a trans or queer
Yes
No
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How did you find me?
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