Name *

First Name

Last Name

Phone

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Contact Method

Call

Text

Email

How would you be paying for services? *

Blue Cross Blue Shield PPO

Blue Choice PPO

Aetna PPO

Out of Network/Super Bill

Self-Pay

Sliding Scale

What are you looking for?

Individual Therapy

Relationship Therapy

Group Therapy

Clinical Consultation

Anti-Bias Consulting

Workshops and Presentations