Let's See If This Is A Good Fit

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This short form helps me understand what’s going on for your child so we can make the most of our consultation call.

Email *

Parent Name:

Phone Number:

Child's Name:

Child's Age:

Do you live in NJ or MA?

What best describes your child's situation?

Diagnosed with Anxiety

Diagnosed with OCD

Suspected Anxiety

Suspected OCD

Not sure, but concerned about anxiety-related behaviors

Clear selection

Is your child currently in therapy?

Yes

Not currently, but has had therapy in the past

Clear selection

What areas are you most concerned about? (Select all that apply)

Bedtime anxiety

Separation anxiety

School-related anxiety

Specific fears/phobias

Reassurance seeking (repeated questions)

Avoidance of fears

OCD-related behaviors (rituals, checking, intrusive thoughts/compulsions)

Other:

What feels the hardest right now?

This program includes practicing skills as you move through it (like brief “homework” activities). Results depend on applying what you learn. Are you able to commit to that?

Yes

Not at this time

Maybe/depends on my schedule

Clear selection

What are the best days/times for me to reach you for a consultation call? (Please provide specifics, for example: weekdays after 5pm, weekends anytime)

After you submit this form, I’ll review your responses and reach out to connect. On the call, we’ll talk through your situation and decide together if this feels like a good fit.

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