Connect for a phone consultation

Wondering how tele-health therapy sessions might be useful? The next step would be to schedule a 15 minute consultation. During this call, we will address any initial questions and see if we might be a good fit. 

Tele-health and video-call session fees are sliding scale and income based. While direct bill insurance is not accepted, superbill receipt can be provided for you to submit to your insurer for partial to full reimbursement.

With the information provided below, I will reach out to schedule a no fee consultation. For your privacy, please do not include any personal health information on this form.

Name *
Email *
Phone number *

Best days and times to call

*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report