I am interested in...

Individual Counseling

Couples/Relationship Counseling

I am open to...

While not currently offering outdoor sessions, I'd like to check your interest in the option

Teletherapy (Video Calls)

Meeting Outdoors

A Combination of Both

Name *

First Name

Last Name

Age of Person Participating in Counseling *

I am not currently offering counseling to children and adolescents

18+

Under 18

What's on my mind...

Select all that apply

I'm facing big upheavals or changes in life

I'm figuring out how to live life after a big loss

I'm having a hard time with work, school, or activities in other domains

I'm having a hard time in a relationship

I or my loved one broke the other's trust...

I'm navigating some changes with my partner(s)

My loved one scares me and I don't feel safe

I'm facing societal challenges and expectations

I'm neurodivergent or think that I might be (inclusive of ADHD, autism, learning differences)

I'm figuring out who I am

I'm really hard on myself

I'm having difficult emotions or moods

I'm struggling with painful memories

I'm having difficult thoughts or feeling out of control in my thinking or behavior

I'm exploring big existential topics

Clinical Rate *

For weekly sessions,

I can pay the going rate of $195 (Couples/Relationship)

I can pay the going rate of $175 (Individuals)

I need a discount, but can pay $135

I can afford a discounted rate of $95

I need a lower fee than the ones offered here

Insurance

I intend to pay without insurance

I can only afford to pay through insurance

I'd like to try to pay through insurance

My Phone *

(###)

###

####

Contact Preferred *

What is the best way to reach you?

Email

Phone Call

Text Message

No Preference

I could be available for a call...

Select all that apply

Mon-Thurs 10am-5pm

Mon-Thurs after 5pm

Fri before 5pm

Sat 10am-6pm

Sun 10am-6pm

Do not call me unless I confirm a call time by email