Name *

First Name

Last Name

Phone *

(###)

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Please note, my normal availability for individual therapy is during business hours, Mon-Fri, 9am-5pm. If this doesn't work for you, I encourage you to seek other resources. Please acknowledge if you can meet during this time. *

Yes, I can meet during these hours

No, I am not available during these hours

I currently accept virtual and in-person clients at my Northridge office. Do you prefer in-person or video appts?

In-person in Northridge

Video

I only accept cash-pay clients (including out-of-network). Are you able to pay the full fee of $200/50-minute session? *

Yes

No

How frequently were you hoping to have sessions?

Weekly sessions are strongly suggested for the first 6-8 weeks of therapy. If you are only able to do every-other-week to start, we can discuss in the call if you're a good candidate for that frequency. I cannot provide therapy for a frequency less than every-other-week.

Weekly

Every other week