Contact

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Email Address

Phone

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Name

First Name

Last Name

Referral Source

How did you find me?

Referral Information

Please share what is bringing you to therapy

Out of Network Insurance Infomation

Please note I am an out of network provider for all insurance plans. Please share if you hope to submit out of network claims in order to get some reimbursement of my fees and what insurance plan you have. Please contact your plan ahead of time and ask if you have out of network benefits and what they cover for the "90847" code (couples therapy) and "90837" code (individual therapy).

Have you reviewed my fees?

If no, please do so before submitting this inquiry.