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First and Last Name
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Name of Your Organization / Company / Practice (if applicable):
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Phone Number
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Which of the following are you most interested in discussing?
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A mutual client
Collaborating - writing, interviewing, researching, speaking together, etc.
Resources on my website - please see the last question. If it is not completed I will likely not respond to your inquiry.
Joining my practice
Social Media
Referrals
Trainings
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If you are contacting me about a shared client, please provide their first name, last initial, and date of birth (e.g., "Anne B., 01/01/2023”).
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Message to Melissa:
I look forward discussing whatever drew you to my practice. Please include the best times to reach you.
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How did you learn about me/my practice?
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Word of Mouth (Friend/Colleague/Other):
A current or former client of Melissa's
We met in person
Google Search
Instagram
Psychology Today
Headway
Monarch
ADDA (add.org)
A professional listserve
A professional association (e.g., NASW, ADDA, NYSSCSW)
An alumni affiliation (UPenn, Columbia University)
ZocDoc
Other
If you were referred by an individual, please provide their name and phone number if you have it. If referred by an organization, please say which one. If we met, please remind me where/when. Thank you! 😊
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Your (or your company) website
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Your (or your company) social media account(s)
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Where are you located?
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If you are contacting me to request to be added to my Resources page, please indicate if your services are offered in NYC.
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Yes my services are NYC-based
No, we are not in NYC
We are National
I am not contacting you to be added to your Resources page
Other:
Thank you for your interest, I hope to connect soon. If you do not receive a reply from me, please feel free to follow up at (646) 504-5458.
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