Client Assessment Application

Would you like to work with me?

Please fill out the Client Assessment Application.

If selected, you will be notified in 3-6 business days. Check your SPAM folder.

Please notify me if any part of the form, link, or email malfunctions. If you were directed here after contacting me, please fill out this form. I will assume you are not a serious client if the form is not received in reasonable time.

Accepted applications get a 20 minute call.

This is NOT a sales call.  
My prices are fully visible on the Services & Prices page.

This is an overview look into 1. the nature of your desire to work with me,  2. evaluating if the issue in within my scope of practice, 3. if another practitioner or modality would be better suited.

The consent form, detailed intake, and assessment forms are sent ONLY after acceptance as a client and the payment is received.

You will get a “Message Sent” with your answers in print on this page when you Submit the form successfully.
I will respond/contact a limit of 3 times if I do not hear from you after the application submission or interest in being a client. After the 3rd time, it will be understood that you no longer wish to work with me or be contacted.

 

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