Contact Me

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Please complete all information in this form and click "SUBMIT" at the bottom of the last page.

It may seem long, but most of the questions require only a check mark, so it will go quickly. If you are unsure of any information, just include your best approximation. All will be expanded upon as necessary as we meet and develop a therapeutic relationship.

This form is required for your initial intake appointment,

so if it is not completed, you will be asked to fill it out in the lobby before seeing me.

I appreciate your co-operation.