CONTACT US

Name *

First Name

Last Name

Phone *

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Type of Therapy *

Individual

Couples

Family

Other

Concerns (Check All That Apply) *

What brings you to therapy?

ADHD

Anxiety

C-PTSD

Career Changes

Chronic Illness

Chronic Pain

Depression

Eating Issues

Grief

Intimacy

LGBTQ+ Identity

Life Changes

Relationship Issues

Religious Trauma

Other

Preferred Therapist (Check All That Apply)

Michal Rogers

Savannah Fine

Lara Rofman

Kat Valentine

Christina Kim

Allyson Byers

Rachelle Ramos

Krista Frank

Jessica Stoya (Sex and Relationship Coach)

Pam Shaffer (ADHD Coach and therapist)

Tas Al-Ghul (ADHD Coach)

No Preference