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Initial Consult Form

I AM NOT ACCEPTING NEW CLIENTS AT THIS TIME


Please read the following prior to completing this form:


Completing this form does not guarantee services, as it will be important for us to determine if we will be a good fit for this work together. After completing this form, you will receive a response via the email you provide about next steps, including scheduling a 15 minute consult call. I will email you at my earliest ability to do so, which is typically within 48 business hours.


During the call, we will discuss what you're looking for and I can answer any questions you have. If we decide it sounds like a good fit, we will schedule a first session. My availability is limited to Mondays only. If we determine that you would be best supported by another clinician, I may provide some resources, though ultimately it will be your responsibility to find referrals.


Caregivers: If you are completing this form on behalf of a child under 13, please indicate this. If you are completing this form on behalf of a teen 13 or older, please complete it with them, or invite them to do so independently.


At the outpatient level of care, change is a process that takes time. If you are in need of immediate support or you are experiencing a mental health emergency, please contact 988 or your nearest crisis response center.


For responses that are not required, share only what feels comfortable and important. I will not share the information on this form with anyone. However, I cannot ensure the confidentiality of any form of communication through electronic media including completion of this form and subsequent email and/or phone communications.

By submitting your phone number, you consent to receiving text messages and phone calls from me at this number, primarily for scheduling purposes.

Date of birth
Month
Day
Year
I'm interested in:

See the Approach page for more info.

How would you like to pay for therapy?
How would you like to meet?
What is your availability to meet regularly on Mondays? Select all that apply. Not all of these times may be available.
How did you find me?
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