Request an Appointment

Emergency Assistance

If this is an emergency, call:

911
1-800-273-8255 (National Suicide Prevention Lifeline)

Please use this form to request an appointment. Before scheduling your first appointment I will contact you by phone to conduct a free 15-minute consultation. During this consultation we can discuss your treatment needs, any questions you might have, and my services and fees.

Client Information

First name

Last name

Date of birth

Phone number

Email address

When should I call you?

Please include a few times/days when you will be available to speak by phone.

Can I leave a voicemail at the number you provided above?

Yes No

About Your Appointment

Reason you are seeking services

If there's anything you would like me to know before I contact you to schedule an appointment, please include it here.

Your information will be encrypted.

Request an Appointment

Emergency Assistance

Client Information

About Your Appointment

Emergency Assistance

Kevin Tarlow, PhD

Licensed Clinical Psychologist