Appointment Request Form
Your Phone Number
Which service(s) are you seeking? (check all that apply)
Online counseling or consultation (telemental health)
Single session (one meeting, online)
Individual therapy for an adult
Individual therapy for a child or teenager
Assessment, testing, or evaluation services
Couples or relationship counseling
Parenting support and/or co-parenting support (coaching/consultation)
Group therapy, games groups, or discussion groups
Consultation on gifted matters, high sensitivity, or high functioning Autism
Age of client(s)
4 years old or younger
5-8 years old
9-12 years old
13-18 years old
19 years old or older
If the client is under age 18, do all legal parents/guardians give consent?
Days you can schedule (days indicated below are in the Pacific Time Zone, please adjust if you are in a different time zone or write in under "other")
Times you can schedule (times indicated below are Pacific Time, please adjust if you are in a different time zone or write in under "other")
3:30pm and after
Please briefly describe what you are seeking help for, and/or share information that would be helpful for us to know.
For information about our professionals, visit:
Rhani Rabago, AMFT: Associate Therapist, accepting new clients, $150 per 45-50 minute individual therapy session (group fee is much lower)
Wendy Rolon, AMFT: Associate Therapist, accepting new clients, $150 per 45-50 minute individual session (group fee is much lower)
Sean M Peterson, AMFT: Senior Associate Therapist, accepting new clients, $150 per 45-50 minute individual therapy session (group fee is much lower)
David Millen, AMFT: Senior Associate Therapist, limited availability to new clients, $175 per 45-50 minute individual therapy session (group fee is much lower)
Deb Simon, PhD, LEP: Licensed Clinical Psychologist, Credentialed School Psychologist, accepting new clients for assessment services, $300 per assessment hour (total assessment cost depends upon type of assessment)
Doug Ronning, LMFT, RDT/BCT: Licensed Therapist, accepting new clients for all groups; individual therapy caseload is full to new clients, $185 per 45-50 minute individual therapy session (group fee is much lower)
Katie Malone, LPCC, LMFT: Lead Therapist, caseload is full to new clients
Grace Malonai, PhD, LPCC, BC-TMH: Director, limited availability, $300 per 45-50 minute therapy/consultation session (assessment fees vary)
First available appointment
Do you reside in the state of California? (for online/telemental health)
If not California, which state, province and/or country do you reside in?
We sincerely appreciate your taking the time to reach out, and look forward to connecting soon.
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