Contact and scheduling

>> Unfortunately, I am currently full and do not have openings for ongoing appointments. << 

Depending on your availability for appointments, a spot could open up soon. Please complete the form so that we can start the communication process despite the lack of available times. I may be able to make suggestions, referrals, etc. I have this form here to manage expectations about availability; but things are often changing and thus the schedule is not predictable. Without a completed form, I won’t know that you’re looking for support when a spot opens up.

Waiting list form

Please complete this form and I’ll be in touch within 72 hours regardless.

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Name
Name
Phone
Phone
Please check off all times and days you are available for an ongoing appointment *
This will help me plan ahead and schedule you as soon as I can. If you don't see a window of time that works for you, it is likely that I do not currently have hours at that time. I do not currently have evening hours.
Please look carefully at the insurances below. *Independence Blue Cross/Personal Choice and Keystone Health Plan East are not the same as Blue Cross/Blue Shield.
Preferred methods of contact
I’m looking to connect with you about (check one or more):