Getting Started

If you’re writing with interest in attending the Mindfulness Based Stress Reduction workshop, please mention that in this note and I will be in touch to share more details.

If you haven’t already, please review the page on my website titled “Counseling” to ensure that you feel like a good “fit” for what I offer to my private clients.

Are you ready to consider becoming a client? Let’s get started!

To make the best use of our time (and avoid phone tag), please complete the form below and send to me by clicking the grey “submit” button.

This is a secure form and what you share is kept in strict confidentiality. Please respond to every question so I can best assist you.

I’ll be in touch with you as soon as possible via email to schedule a consultation, or to offer a referral if I am not able to accommodate you or if I feel you would be better served elsewhere. Thank you very much.

Contact Details

Name (please share First name only):(required)
Phone number (include area code):
Email:(valid email required)

About You

Health Insurance Plan:
How did you hear about me?
Were you referred by your physician? (If yes, please share name of physician):
Are you seeking individual counseling?
yes no
Please describe briefly your reasons for seeking support:
Have you ever been diagnosed and/or treated for a psychological disorder?
yes no
Have you ever been hospitalized for psychiatric care?
yes no
Are you having suicidal thoughts and/or experiencing a crisis?
yes no
If you're experiencing a crisis, please call the Third Level Crisis Center at: 922-4800, or call 911, or present yourself at your nearest emergency room.
Please share times you are generally available to schedule an appointment:

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