Ready to connect?

Name *

First Name

Last Name

Phone *

(###)

###

####

Do you prefer online or in-person sessions? *

San Diego in-person therapy sessions are only offered on Tuesdays. Telehealth sessions are offered on Mondays, Wednesdays, and Thursdays.

In-person therapy

Online therapy

Whichever is available sooner

What is your availability? *

Times indicated are session start times; please select all that apply. If you require a particular day or time, please let me know in the information box at the end of this form.

Mornings (9am-11am)

Afternoons (12pm-3pm)

Evenings (4pm-5pm)

Is my private pay fee within your budget? *

Yes

No