Contact

Use the form to request an appointment or to speak more about your counseling needs.
I will return your message as soon as possible. Please note if you prefer to be contacted via email, phone, or text. If via phone, also indicate if you are ok with having a message left if you miss my call.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Preferred method of contact

Please note how you would prefer I return this contact request:

Are you a new client?

Yes

Service

Select a type of service

Date

Please note a date you would like to start counseling. I will make every attempt to match the date/time requested, or the nearest possible that works for you.

YYYY

Time

Please note an appointment time that would work for you on a recurring basis.

Comments or Questions

Cancellation Policy: To avoid a $50 fee, notify me at least 24 hours prior to your appointment to cancel or reschedule.

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