New Client Interest Form
Thank you for expressing your interest in working with me. To expedite communication, I ask that you complete this form. If you have questions, please do not hesitate to contact me.
Name *
Email *
Insurance *
Please select all times that you are available for an ongoing appointment: *
Please note that I cannot guarantee when space will be available in my practice. If I am unavailable during your available time, would you prefer to be added to a waitlist? *
Please know that I strongly encourage you to continue looking for a provider with immediate openings, as I cannot anticipate when space will be available in my practice. Please refer to or for clinicians with immediate availability.
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