Session Request

Submit your Request for Therapy here:

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Your Name *

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Your Phone Number *

Your Email *

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 $160.00/2Hr. 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: *

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