First name/Last name /Pronouns * Email * How did you find this practice page? (Were you recommended by anyone or did you find me on your own?) I understand this practice is private pay and in person Snapshot You are welcome to share briefly and we'll cover anything else needed in a call. Phone # for the consultation (###) ### #### Consultation Time Preference Usually complimentary consultations are on T/TH/F Early afternoon Late afternoon/ Early Evening Preference for email or text message follow up response? Email Text message Thank you so much for reaching out and taking this major step toward feeling relief! I’m looking forward to connecting with you! LET’S CONNECTGet in touch.
