Secure Contact Form

Intake Psychotherapy & Wellness, LLC

Please correct the errors described below.

Please provide the best time to contact you and/or a date in which you would like to scheduled your consultation. Consultations are conducted:

Monday - Thursday 9:00 am, 11:00 am, 2:00 pm, 3:15 pm, 5:45 pm, and 7:00 pm

Friday: 9:00 am, 2:00 pm, 3:15 pm, 5:45 pm, and 7:00 pm

Please note the above times may not always be available if someone has scheduled a consultation previously. However, I will attempt to accommodate you but if I cannot I will reach out to provide a specific dates and times that are available.

If you are interested in group therapy please select the type of group therapy you are interested in:

Speaker request on Mental Health Issues

Upon submitting this form, any correspondence with you will require a password to ensure your privacy. Providing me with a question and an answer that only you will know helps to ensure your privacy through encrypted email and lets me know I am communicating with the correct person via phone or video conferencing.

Here are two examples of a question you may choose to provide. (i.e. What is my mother's middle name? or Who is my favorite superhero?) However, choose a question and answer that is easy for you to remember but only you will know.

Your information will be encrypted.

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