Appointment Request

To schedule an individual, children, couples, DOT/SAP appointment or to obtain additional information about any of these counseling services, please fill out the form below or give me a call. 877-957-3422 X701 or send an email.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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Please do not submit any Protected Health Information (PHI).

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