If you are interested in one-on-one consulting, please fill out the below intake form and I will get back to you within 48 hours.

Name

First Name

Last Name

Legal Name (If different from above)

First Name

Last Name

Pronouns

Email Address

Date of Birth

MM

DD

YYYY

Relationship Status

Are you currently seeing a therapist?

If yes, for how long have you been seeing this therapist?

Do you have a support system? If so, who are they?

What are three things you would like to work on?

How much time or energy do you spend thinking about the things you listed above?