Please do not include sensitive personal information on this form.

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Submit" you agree to hold Free to Feel Therapy harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Note: I am happy to provide a superbill for submission to other insurance providers for potential reimbursement.

We’ll briefly talk about what you’re experiencing, I’ll answer any questions you have, and we can decide if I’m the right therapist for you.

Fill out the form below and on the next page, schedule a phone call onto my calendar.  You will receive a follow-up email confirmation from me within 2 business days.

Schedule a free consultation call!