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First Name *

Last Name *

Email *

Phone Number *

Seeking Therapy For *

Please note that I do not treat couples or children under age 10. *

Who were you referred by? *

Please briefly describe your primary reason(s) for seeking treatment: *

How do you plan to pay for sessions?

Please note that I only accept self-pay and Aetna, Cigna, Oxford, United Healthcare, & Oscar Insurance. For all other insurance plans, you will do self-pay with the option of having a receipt that you can submit to your insurance plan. *

Is the person(s) seeking treatment willing to do virtual sessions? *

All sessions are virtual *

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How do you prefer to be contacted? *

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