Free Consultation Request
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Name *
Email *
Number *
State you reside in *
Brief reason for seeking services *
Do you plan to use insurance?
(Please note: Dr. Darleen only takes certain insurances. Please view my Psychology Today profile to see full list) *
If so, which one? (If not applicable, write in "n/a") *
Please select days and times you're generally available to chat by phone for a consultation *
Morning (9-12p)
Midday (12p - 5p)
Evenning (5p - 7:30p)
Monday
Tuesday
Wednesday
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Saturday
Do you consent to be contacted by call or text by Dr. Darleen for this consult? *
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