Welcome to Our Hopeful and Holistic Healing Center!

I'm excited to connect with you during your complimentary 20-minute consultation.

Please note that this session is an opportunity to discuss your needs and interests. Although this call does not establish a patient-client relationship, all information provided will be treated confidentially and in accordance with privacy laws.

I appreciate you completing this brief form so we may discuss how I may learn about your well-being journey and where I may potentially fit. If we do not receive your response at least 48 hours before your 20-MINUTE consultation, we will cancel the appointment in order to give you time to fill out the form so then you may reschedule.

Ex. If 20-minute consultation is scheduled for July 7th at 1:30 pm, we need to receive this completed form before July 5th at 1:30pm.

FYI my practice does not accept insurance, although we can provide a superbill that you can submit to your insurance for partial reimbursement if you have a PPO. You can see a list of my fees here

please complete the form which is hyperlinked and also pasted here:

https://intakeq.com/new/l28qul

Thank you

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As a reward to yourself, plese schedule a free 20-minute consultation below.

THANK YOU FOR COMPLETING THE brief 20-minute intake FORM.

PLEASE FEEL FREE TO SCHEDULE YOUR 20-MINUTE COMPLIMENTARY PHONE CALL below.

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