Schedule a Consultation or Session

Name *

First Name

Last Name

Phone *

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I'm interested in support with... *

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Anxiety

Depression

Relational Issues

Grief and/or Loss

Stress

Body Image

Women's Issues

Spirituality

Identity-Related Issues

Addiction

Eating Disorder

Sleep Changes

Other

Please check the times you are available for week-day weekly appointments (M-Th). I recognize this might vary day to day, so please answer in general terms. *

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8am-10am

10am-12pm

1pm-5pm

Please check the box to confirm that you know I do not take any insurance directly. Information about my fees can be found in the Services section under "Services and Fees." *

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