Contact Me Name * First Name Last Name Email * Phone * (###) ### #### Subject * Message * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth Prospective Clients: Please provide your date of birth to ensure accurate record-keeping and to assist with insurance verification. This information is necessary to process your intake efficiently. Service Preference All services are virtual. Individual Therapy Group Therapy Couples Therapy Clinical Supervision Case Consultation Life Coaching (non-clinical, self-pay) Thank you!
