Fill out the form below to apply for ongoing therapy.
Name*
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Email*
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Phone*
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Describe your therapy history: What went well? What didn’t? Why did you stop working with your previous therapist(s)?*
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What do you want to achieve in therapy with me? How old are you, and what current life situations are you currently struggling with?*
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Please provide a brief list of the types of traumas you have been through. You don't need to go deeply into details. Imagine this being a bullet list. I know it's a tender thing to simply list, but it will help me better understand your healing needs.*
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On a scale of 1-10 (1 = crisis;10 = amazing) how are you functioning day-to-day right now?*
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Do you use recreational substances? If so, what are they? Please describe quantity and frequency.*
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Are you on any medications?*
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Have you ever been diagnosed with anything? Please describe.*
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Why do you want to work specifically with me? (Make sure you have read the statement about how I work before answering this question)*
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Do your finances allow you to work more or less weekly, ideally, for about 3 months before downsizing? (Weekly work with me is $250 per session; $260 bi-weekly; $275 for couples. Sporadic work or one-offs are $275 per session. If this cost would be stressful for you, I encourage you to explore whether one-on-one therapy is the best idea for you at this time. I do not encourage people to do this work if the cost creates a financial stress that counteracts the benefit.)*
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Is there anything else you would like me to know about you as far as your desire to heal alongside me?*
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Please confirm that you understand my 48-hour cancellation policy once your session is booked; refunds are not available for sessions cancelled with less than 48-hour notice.*
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