First Session Request
Thanks so much for your interest in working together!

To request a first appointment, please complete this form, and I will get back to you as soon as possible :)
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Email *
Name (First & Last):
Nickname or Preferred Name (if applicable):
Date of Birth:
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Today's Date:
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Phone number:
Where do you live?
Do you live in Alabama?
Are you completing this form on behalf of a loved one, or are you seeking these services yourself?
Are you 18 years old or older? (Note: I am only able to work with clients who are older than 18)
In your own words, what are you looking for? (If you already sent a message, you can copy and paste it here.)
Please select which of the following services you are interested in.
What sort of therapy have you tried before?
Do you currently have a therapist? (Our work together can supplement the work you are doing with a primary therapist, if appropriate, or can be done independently.)
Do you have a history of substance abuse, or some kind of relationship with substances that might be considered addictive or problematic?
If you would like to share any additional details regarding any history of substance abuse, please include them here:
Have you ever been diagnosed with any kind of mental health condition? (Note: I aim to see you as a complex person and fellow human, and not as a mental health diagnosis. At the same time, identifying patterns of symptoms and behaviors can help us determine how we might be able to work together most effectively.)
Is there anything else you would like to share?
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