Appointment Request Form

If this is a mental health emergency, please do not use this form. Please call one of the resources below instead:

Thank you for your interest in working together!

Please provide your contact information and availability below to request a free 15-minute phone consultation.

First name

Last name

Email address

Phone number

Please let me know about the best days/times to call you for a free 15-minute consultation.

Please let me know the days/times you are available to schedule future therapy appointments.

Please note, I am available for appointments between 9:00 am to 4:30 pm Monday through Friday. I offer both in-person and virtual appointments.

Please share briefly about your therapy goals and presenting concern.

If there's anything else that you would like me to know prior to your appointment, please include it here.

Your information will be encrypted.