Which services are you seeking? *

Individual therapy for myself

Individual therapy for someone else

Professional consultation

I offer both video and in-person sessions depending on availability. How do you hope to meet? *

I am interested to meet via video

I am interested to meet in person

I do not have a preference or would be comfortable with either format

Name *

First Name

Last Name

Phone Number *

(###)

###

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I am in-network with Blue Cross Blue Shield (BCBS) health insurance for North Carolina residents. If this is your primary health insurance, do you wish to use it for our sessions? *

If BCBS is your secondary or supplemental insurance, I would be unable to bill it for therapy sessions.

Yes, I am a North Carolina resident and wish to use my BCBS insurance

No, I would pay for sessions directly

My availability is currently limited to weekdays and I do not currently have openings before 9:30 or after 4:30. Could that work for you? *

Yes, I have some availability to meet during those hours Monday - Friday.

Yes, but I have very limited weekday availability (if so, please note availability below under Additional Information)

Are you seeking therapy related to any past, current, or expected future civil or criminal court case? *

No

Yes - please briefly describe under Additional Information