New Client Inquiry

Please complete the form below. Your responses will help me understand what brings you to therapy and determine whether my clinical experience and areas of specialty are a good fit for your needs.

Please answer the questions as best you can. If there's anything you'd rather not answer right now, let me know. We can always discuss it later.

This is not a clinical assessment or a formal consent for treatment. New client paperwork and informed consent documents will be completed before your first appointment.

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Full Name *
Email  *
Phone *
How old are you? 
What State(s) do you live in?   *
Required
What is bringing you to therapy?  *
Select any issues/symptoms you are currently experiencing:   *
Required
Would you like me to contact you to schedule a free 15-minute consultation call? *
Would you like me to contact you to schedule your initial intake appointment?  *
Is there anything you're curious about or any questions you have for me?  *
Alchemy Counseling does not take insurance  *
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