Submit your Request for Therapy here:
Your Phone Number
Check your understanding of why you are contacting me:
I have read and I understand the information and terms on the "Legal" page.
I have read and I understand the "Rates" page $150.00/2Hr. session and the typical length of your sessions are 2 Hours.
I understand that I am contacting you because I want to make a change.
I understand that we will work as a team to make that change happen.
I understand that my stated and unstated or secret goals for this session are in sync with each other.
Name of referring person and Please provide a description of the reason or purpose of your requested session:
Please give as complete and succinct explanation of your request and the name of the Referring person/office. Thank You.
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