1-on-1 Sessions


1 on 1 Sessions Application

Thank you for joining my private practice waiting list. Please take a moment to complete the information on this form. If there’s something you especially want me to know about your process or experience at this time, feel free to add it in the last section below.

Personal Details

How long do you feel you can wait before beginning work with me: *
If your needs are immediate, and I am unable to take your case, I will be happy to refer you to practitioners who may be able to work with you in a more timely fashion. Please check the YES box if you’d like a referral.

When completing this form, your responses will be collected only for us to review your application. Please read our Privacy Policy to see how your data is used and stored.

Once you click submit, you’ll receive an email indicating my next steps, based on the information you shared in this form. Thank you for taking the time to connect with me.