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How Can We Help?

Please Note: This form is for general inquiries only and is not secure or HIPAA-compliant. Please do not share personal health information. Submitting this form does not establish a therapist-client relationship.

If you are experiencing a crisis or emergency, please call 911 or contact a local mental health crisis line.

Name

First Name

Last Name

Phone

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Email Address

I’m interested in...

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Individual Therapy

Couples Therapy

Co-Parenting Planning & Therapy

EMDR

Retreat, Classes, or Workshops

Support Groups

Short Term Therapy

EMDR Intensive

Other

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Do you have a preferred time to contact you?

Is it OK to text to schedule a 15 minute phone consultation?

Where are you located?