Please read the following prior to completing this form:
Completing this form does not guarantee services, as it will be important for us to determine if we will be a good fit for this work together. After completing this form, you will receive a response via the email you provide about next steps, including scheduling a 15 minute consult call. I will email you at my earliest ability to do so, which is typically within 48 business hours.
During the call, we will discuss what you're looking for and I can answer any questions you have. If we decide it sounds like a good fit, we will schedule a first session. My availability is limited to Monday afternoons and early evenings at this time. If we determine that you would be best supported by another clinician, I may provide some resources, though ultimately it will be your responsibility to find referrals.
Caregivers: If you are completing this form on behalf of a child under 13, please indicate this. If you are completing this form on behalf of a teen 13 or older, please complete it with them, or invite them to do so independently.
At the outpatient level of care, change is a process that takes time. If you are in need of immediate support or you are experiencing a mental health emergency, please contact 988 or your nearest crisis response center.
For responses that are not required, share only what feels comfortable and important. I will not share the information on this form will with anyone. However, I cannot ensure the confidentiality of any form of communication through electronic media including completion of this form and subsequent email and/or phone communications.
