Name *

First Name

Last Name

Pronouns *

Select all that resonate and only share what you're comfortable with.

she/her

he/him

they/them

Prefer not to say

My pronouns aren’t listed

Phone *

(###)

###

####

I am only licensed in the state of Washington, by checking this box you confirm that you are currently living in the state of Washington. *

I am!

I do not accept any insurance as method of payment for therapy.

We can, however, provide a superbill for you to submit for potential reimbursement from your insurance company.

Got it!

Are you seeking individual or relationship therapy? *

Individual Therapy

Relationship/Partnership Therapy

Do you prefer in-person or telehealth (virtual)? *

In-person at your tacoma office

Telehealth (virtual) session prefered

I am open to either format

To schedule your free 20-minute consult, please share what times are best to reach you. *

Consults calls will be conducted Monday - Friday

Morning (9am-11am)

Afternoon (12pm-3pm)

Evening (4pm - 5pm)

Please note that I will NOT be contacting clients for consult scheduling until late September. *

If there are any delays, you will be informed via the email provided.

I understand!