Name *

First Name

Last Name

What are your preferred pronouns?

She/Her

He/Him

They/Them

Other

Will you be living in the State of California or Florida while in therapy? *

I am licensed to practice in the state of California and Florida, I cannot take you on as a new client if you will be living out of these states during the time you plan on being in therapy.

Yes I live or will be living in California or Florida

No I will not be living in California or Flordia

Who are you seeking therapy for? If for someone else, read below

I am exclusively accepting adult individual and couples therapy clients at this time. If you're contacting me on behalf of a loved one, kindly provide your contact details instead of theirs. Answer the subsequent questions from your perspective as accurately as possible, and schedule the phone consultation for yourself. During this consultation, if I determine that I can provide assistance to your loved one, we can discuss scheduling a follow-up consultation involving them.

Myself

My Partner and Myself

A Loved One

What kind of therapy are you seeking? *

Couples

Individual

Couples Workshop

Will you be using insurance or paying out-of-pocket for the cost of psychotherapy? *

Keep in mind that my private fee for a 50-minute individual session is $150, and for a 50-minute couples session, it is $200. If you are covered by Atena or United, I will manage the billing process, and you will be responsible for paying the co-pay and deductible. If you have a PPO plan that is not Atena or United, I can supply you with a superbill that you can submit to your insurance for potential reimbursement. In all instances, it is your responsibility to be aware of what your insurance plan covers.

I will be paying out-of-pocket

I will be using my Aetna or United insurance policy

I will be paying out of pocket however have a PPO plan and would like a superbill