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Email
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Your email
Preferred Name /
Nombre Preferido
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Phone number /
Número de teléfono
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Your answer
Reason for seeking therapy /
Motivo de búsqueda de terapia
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Anxiety / Ansiedad
Depression / Depresión
Stress / Estrés
Grief, loss or recent life change / duelo, pérdida o cambio de vida reciente
Relationship challenges / desafíos de relación
Family conflict / conflicto familiar
Other:
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Therapist you are inquiring about /
Terapeuta sobre el que preguntas
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Dr. Sam Hill
Ramon Sanchez, ASW
Brittney Grimes, AMFT
Sheila Grant, ASW (Telehealth Only)
Any team member
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Additional information you'd like us to know /
Información adicional que le gustaría que supiéramos
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How did you hear about us? /
¿Cómo te enteraste de nosotros?
Instagram
Psychology Today
Referral
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