Let’s work together I’m glad you’re here because this means you’re curious about change. Name * First Name Last Name Pronouns Date of Birth Needed to set-up portal access MM DD YYYY Email * Phone * (###) ### #### Insurance Carrier * Availability for Sessions * Evenings are highly desired and openings are infrequent Format Preference In-Office Virtual What are you hoping to work on? Anything else you'd like me to know? * Thank you! I will reach out when something matches your availability.