52 — Application
Thanks for this. Filling out an application is already more than most men ever do about this, so — good.

Take a few minutes on it. I read every one myself, and what you write here is what we will actually spend the call on. Your answers come straight to me and are not shared with anyone.

This form is not a patient portal and is not for urgent concerns. If you are in crisis, call or text 988, or go to your nearest emergency department.
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Your name *
Email *
Mobile *
So I can send you a booking link, and so we can reach each other if a call needs moving.
What city do you live in? *
What state? *
California is at the top of the list. Tip: open the list and press the first letter of your state to jump to it. I am licensed in California, so that is where I can provide medical care — if you are somewhere else, fill this out anyway. I am building something for men outside the state and I want to hear from you.
How did you hear about this? *
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