Therapy Contact Form (secure)

If you are in the need of crisis support, please call 988 (if in Sonoma County) or 911 to receive the help you need in this moment.

First name

Last name

Email address

Phone number

Age

Pronouns

Breifly, share why you are looking for thearpy at this time.

How did you hear about me?

Preferred times for sessions (days/times)

Payment My fee is $165 for 50 minute sessions. I can provide a monthly superbill, which is a receipt for services, upon request for out-of-network reimbursement. Many insurance providers offer reimbursement for out-of-network services, but you are responsible for full payment at the time of each session. Please check with your insurance provider to confirm which services are eligible for full or partial reimbursement.

Private Pay Aetna Insurance

I understand this form is for consultation purposes only and does not establish a therapeutic relationship.

I understand

Your information will be encrypted.