Name *

First Name

Last Name

Phone

(###)

###

####

What services are you interested in?

Individual Therapy

Couples/Relationship Therapy

Group Therapy

EMDR Therapy

We don't accept insurance, and our fees are $130 for individuals and $160 for couples (rates pro-rated for longer sesssions). Does this work for your budget for self-pay? *

Yes

No

Depends, I have some questions.