Hello,

Thank you for your interest in working with me. Please fill ou the information to the best of your ability, and I will respond within 24 business hours, if not sooner.

Reach Out

Name

First Name

Last Name

Email

Phone

(###)

###

####

I Understand that Therapy is provided ONLINE only.

Yes

No

The Insurance That I Have is:

Chorus Community Health Plan (CCHP)

Straight Medicaid

Medicare Part B

United Health Care

Self Pay

How did you hear of us?

Best Way To Contact Me Is:

Email

Phone

If Phone, The Best Time to Call Me Is:

What Do You Want To Achieve In Therapy?

Please fill out the information below:

What Happens Once You reach out

Consultation Call

We will have a 15 mins phone consultation to make sure that you and I are a good fit.
Create a patient portal

If we are a good fit, we will schedule our first appointment. Between meeting, you will create a patient portal and fill out all intake paperwork.
First Appointment

We will meet via telehealth to review all paperwork signed and answer any questions. A diagnosis will be discussed at this time.
Reoccurring appointments

It is recommended to do 4 weeks of weekly therapy appointments and then reassess from there.