Let’s Get You Started… Please fill out the form below to get started and I’ll get back to you within 2-4 business days. Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth (Client) * MM DD YYYY Please provide preferred days and times for weekly sessions * Do you have out of network benefits? * Yes/No/Unsure Briefly tell me a little bit about what brings you to therapy or what you are hoping to gain. Please don't worry about adding lots of details. If we move forward with an intake, we will have time during our first session to explore your history and goals more in depth. Please select the services you are interested * Individual Treatment EMDR Couples/Family Treatment Mindfulness/Yoga Training How did you hear about me? Thank you!