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Client Information

Date and Time Requested:

I'm available Tuesdays and Wednesdays from 3-6 PM, variable. Appts will likely be scheduled the week after the request is made.
My appointments are 30 minutes and start on the half hour
My appointments are 30 minutes and start on the half hour
I'm available Tuesdays and Wednesdays from 3-6 PM, variable. Appts will likely be scheduled the week after the request is made.

About Your Appointment

If there's anything else that you would like me to know prior to your appointment, please include it here. Please contact us at 505-990-486 if you have concerns about this form or this service.

By checking the box below, I consent to professional services from Peopleworks-NM. I understand this service is free of charge. I understand the service will be rendered remotely, via phone or possibly video if I request. I understand that if I divulge abuse or neglect, the staff member may have duty to report to authorities. The staff member will create a short note about topics covered, which will be stored in a secure cloud storage with Peopleworks. Our staff are bound by privacy laws, as this service may entail discussion of private healthcare information. Please give us 24 hour notice of cancellation at admin@peopleworksnm.org.

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