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Please provide the following information if you are interested in setting up a first-time appointment.  Your answers will allow us to determine if we are able to meet your needs. We will respond to you via email and provide instructions to submit insurance information and new client forms.   Thank you for providing this important information.  

Copy and paste the following information into your message, or send an email directly to: [email protected].

1. Do you wish to use health insurance for services? If so, please name your carrier.  Though we may be listed in your member portal, we may not be currently accepting certain plans.  Based on availability,  we are accepting the following plans:

  • Aetna
  • Anthem Blue Cross (Blue Cross Blue Shield)
  • Optum
  • Motion Picture
  • Providence
  • United Health
  • Other  PPO plan (or out of network plan)
  • Cash 

2. Are you setting up a standard visit or an EAP visit?  If using insurance, we will ask you to submit a copy of your card (front and back) along with your date of birth to confirm your benefits before setting up an appointment unless you are not using health insurance. If you have an EAP code, we'll ask you for your authorization number before we set up an appointment.


  • Standard
  • EAP

3. What days of the week and time of day are you seeking services? (Provide the widest availability possible).  We are open Monday - Thursday 11:00-6:00 PM.  We do not offer appointments on Friday, Saturday, Sunday.

4. Who is seeking treatment?(List ages for a minor children):  We generally do not see children alone under 12 years old unless the parent is seeking shared sessions with their child.  If you are seeking help with children under this age without a parent present, look for a child-specific practice.  We offer a communication-based practice (and therapy)  for individuals, teens, young adults, families, couples, and adults.

5. What kind of therapy are you seeking? (Couples, Family, Individual)

6. In general, what is the primary need for therapy? (Stress, Depression, Divorce related, Occupational concerns, Communication, Relationship Help, Family, etc.)

Thank you for providing answers to these questions.  We will respond within 24 business hours or less to determine the next step in setting up your first appointment!  

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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Helpful Forms

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