Name *

First Name

Last Name

Phone *

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How do you prefer to be contacted to schedule our initial phone consultation? *

Phone

Email

What type of service(s) are you interested in? *

Select all that apply.

Medication Evaluation & Management

Therapy

Mental Health Services for Seniors

I am an out-of network provider and do not participate on any insurance panels. This allows me to fully treat patients according to their needs, and to individualize the pacing of treatment according to patients' preferences and best practices in mental health care. I do provide statements for out-of-network insurance reimbursement for individuals who have this coverage. Please confirm you would like to proceed. *

I understand.