Let’s Work TogetherPlease fill out the form to the right and I will get back to you within 48 business hours. Name * First Name Last Name Client Date of Birth * MM DD YYYY Email * Phone Number * (###) ### #### Insurance * Blue Cross Blue Shield PPO United Healthcare PPO Aetna PPO Other/ No Insurance Sliding Scale How are you looking to get started? * 15 minute phone consultation Ready to book my first session Are you looking for in-person or Telehealth? * In-person Telehealth Hybrid What is your availability? * Please check all that apply Morning Afternoon Evening Anything else l should know? How did you hear about me? Thank you!