First Step Survey
Please take a moment to fill out the following questions so that I can determine how I can best help you. I will get back to you as soon as possible with a recommendation.
Email address *
Name
Your answer
What brings you for help? *
Required
If interested in one-on-one in-office therapy, what is your availability for sessions? *
For one-on-one therapy, what payment options work for you? I am no longer able to accept United or Tricare.
In your own words, how do you think I can best help you?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.