Thank you for considering us
for your counseling needs

Please request an appointment by
filling out the form below.

Be sure to include preferred days and times
so we can better meet your needs.

Name
Email Address
Phone
Comment	If you have mental health insurance please let us know. If you want us to contact your insurance provider to determine your coverage please include the following information in your comments:
	* Client's name and date of birth * Insurer's name and date of birth (if different) * Company insurer works for and group/policy number * Insurance company and phone number

What to expect on your first visit ...

Please arrive at the office 10 minutes prior to your appointment so that you may complete a new client information form. Upon arrival you will find the client information sheet on a clipboard with my name on it and the appointment time. After gilling out the form flip the switch next to my name and make yourself comfortable. During the beginning of our first session I will briefly review the information sheet to make sure I have all information required for my records. I will also explain our policies regarding confidentiality and fees associated with your therapy. Ask me any questions you have about therapy; as I am there to serve you and to make you comfortable during this process.