Request for Wait List
Please provide the following information in order to be added to the wait list. Because I do not take on additional clients until current clients have completed their work, it is hard for me to know with certainty how long it may be before a time slot opens up. When I have an opening available, I will send you an email and you will typically have 24-48 hours to respond in order to hold your slot. I am also always happy to provide you with referrals to other counselors as it is most important to me that you get the support you need, whether or not it is with me. Please email me at
to request counselor referrals.
Full name(s) of clients who wish to participate in therapy
Type of therapy requested
Individual Therapy - Adult
Brief statement (roughly one or two sentences) about why you are coming in
Method of payment you will use (please contact me if you would like me to check what your out-of-network benefits might be)
Blue Cross Blue Shield
Private Pay/Out of Network
Anything else I need to know?
Please be aware that I read these messages infrequently. If you need a relatively quick response, please call or email me at firstname.lastname@example.org
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