Let’s Talk

Your Name *

First Name

Last Name

Questions requiring responses:

Please add me to your waitlist (complete the remainder of the form)

I am seeking services other than psychotherapy sessions.

I have weekday availability and am interested in a free phone consult

Your Phone Number: *

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What service are you interested in? *

Individual Psychotherapy

Clinical Supervision

Workshop/Presentation

What is your preferred way to be contacted? *

Phone

Email

Either is fine

Are you interested in telehealth or in-person appointments?: *

In-person

I'd prefer Telehealth

Are you interested in appointments on a weekly basis or every other week? *

Weekly

Biweekly

Do you have Aetna insurance, out of network benefits with another insurance company, or will you paying out of pocket? At this time I am credentialed only as an Aetna provider.

Aetna

Out of network benefits with another insurance provider

Out of pocket