Request an Appointment

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Please note: At this time, we have a very limited number of face-to-face counseling appointments available and only individual counseling appointments are currently being offered face-to-face. If you request a face-to-face appointment, you may be placed on a wait list for 6-8 weeks or more.

Most of our counseling and coaching sessions are being conducted by video (telemental health/telehealth) and this form is built primarily for that purpose.

Client Information

Date & Time

Please indicate which days work best for you
We offer appointments as early as 8:00 AM and as late as 6:30 PM

About Your Appointment

Please select your insurance carrier or select "none" for private pay/cash.
If there's anything else that you would like me to know prior to your appointment, please include it here.

I understand that if I am submitted a request for teletherapy with a clinician employed by Dynamic Counseling and Coaching Solutions, L.L.C. that “teletherapy” includes consultation, treatment, transfer of medical data, emails, telephone conversations and education using interactive audio, video, or data communications. I understand that teletherapy also involves the communication of my medical/mental information, both orally and visually.

I understand that if I am submitting a request to engage in face-to-face counseling, I may be placed on a waitlist for 6 to 8 weeks or more,

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