Dr. Freeman's New Client Contact Form

Urbandale, Iowa

Full Name

Phone

Email address

What insurance do you have? (Note, career counseling is not covered by insurance).

Your date of birth (MM/DD/YY)

City and state

Please tell me what issues you are wanting to work on at this time?

My availability for therapy sessions is typically Monday-Thursday between the hours of 9:30am and 3pm. Do these times work for you?

How did you hear about me?

Do you prefer telehealth or in-person therapy? Note, I am located in Urbandale - a suburb of Des Moines.

Telehealth In-person

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