The inquiry form is optional. Please fill out the form below if your preference is to contact me via email. I welcome both email and phone calls.
Required fields are marked with asterisks (*).
Contact Name:(if different than above)
Relation to Patient:
Home Phone: *
Email Address: *
How would you prefer to be contacted?
What concerns bring you to counseling at this time?
Are you planning to use insurance?
If yes, please consult with your insurance plan to verify if I am a recognized provider in your plan.
It may take a moment to submit your information. Please wait for a confirmation message.