Thank you for interest in working with me. Let's get started!
PLEASE READ CAREFULLY.
You must be 18 years or older to complete this form. Submitting this form is NOT an agreement to begin treatment services. This page and website also are not monitored 24/7. If you are having a medical or mental health emergency, please call 911 or visit your local emergency room. For crisis and community resources, please visit my client resources page at
here.
- Fill out this form in its entirety.
- Once completed, please schedule your consultation call here.
Your form will be reviewed within 24-48 business hours.
I look forward to hearing from you!