Contact and scheduling

>> Unfortunately, I am currently full and do not have openings for ongoing appointments. << 

Depending on your availability for appointments, a spot could open up soon, but unlikely prior to September 2019.

However, please continue reading below.

Please complete the form so that we can start the communication process despite the lack of available times. I may be able to make suggestions, referrals, recommendations, etc. I have this form here to manage expectations about availability; but things are often changing and thus the schedule is not predictable. Without a completed form, I won’t know that you’re looking for support when a spot opens up.

Waiting list form

Please complete this form and I’ll be in touch within 72 hours

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How did you hear about me? *
Please check off all times and days you are available for an ongoing appointment *
This will help me plan ahead and schedule you as soon as I can. If you don't see a window of time that works for you, it is likely that I do not currently have hours at that time. I do not currently have evening hours.
Preferred methods of contact
Please select your method of payment for services
Please look carefully at the insurances below. *Independence Blue Cross/Personal Choice and Keystone Health Plan East are not the same as Blue Cross/Blue Shield.
I'm looking for the following services:
Check all that apply
{Optional} Please check of symptoms you are experiencing:
What will have changed for you when you accomplish therapy goals?
Emergency *
I understand that if I am having thoughts of harming myself that I need to call 911 or go to my nearest emergency room. This form is not a consent nor a guarantee for treatment.
Please include any other information you feel is important for me to know.