Name *

First Name

Last Name

Pronouns *

she/her

him/her

they/them

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!

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

Morning

Afternoon

Evening

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!