By submitting this form, you agree to the following:

• Submitting an inquiry does not guarantee therapy services, scheduling, or availability.

• Completing this form does not establish a therapist–client relationship.

• Information shared through this form is used only to respond to your inquiry regarding services, scheduling, or payment options.

• Your contact information will not be shared, sold, or used for marketing purposes.

• Electronic communication may not be fully secure. Please avoid sharing sensitive medical or diagnostic information through this form.

• If services move forward, formal intake paperwork, consent forms, and clinic policies will be provided prior to the start of therapy.