Contact

This form is not HIPAA-compliant. Keep this in mind when submitting personal health information (PHI).

Ok, got it.

Name

Phone Number

Please ONLY submit this form if you are genuinely interested in getting started and want to see if we are a great fit/really want to learn more. ***I set aside time to respond to you and save a spot for your genuine interest in getting started!

Got it! Yes, I am motivated and genuinely interested in getting started.

What is your motivation, 1 out of 5 (5 being highly motivated) to get started, get relief, and make progress?

How did you hear about us?

We are an out-of-pocket practice. Session fees range from $ 180 to $250.

Ok, got it.

Therapy is available for clients in Florida, Michigan, or Vermont ONLY. Coaching is available anywhere.

Ok, got it. I'm within those locations!

What are you struggling with the most and hoping to get relief around?

Would you like us to reach out to you by texting you or by emailing you?

If you selected to be “texted” above, please type the phone number you want us to text you at OR put “N/A”:

Thank you for filling out this form, we will get back to you in less than 24 business hours! Please make sure to check your junk mail.

Ok, got it!

Contact

Stay Connected