Name *

First Name

Last Name

Phone *

(###)

###

####

Which service are you interested in?

Individual Therapy

Group Therapy (Sober-Curious Group)

Out of Network Provider Acknowledgment *

I acknowledge that you are an out-of-network provider and the cost is $185 per 50 minute session (Please see my Rates&Info page for more information on out-of-network benefits)

Got it!