Now Accepting New Patients

Your personal information will always be kept private.

First Name *

Last Name *

Phone *

Email *

I understand that submitting this form is an inquiry for services and does not constitute a therapist-client relationship until formally established. I also agree that I am providing contact information so that I may be contacted regarding this inquiry.

Indicate your main reason for contacting Jennifer? *

If you want share one or two things you'd like Jennifer to understand about your current situation or what you're hoping to achieve, what would those be?

Connecting with Jennifer

What is the best way for Jennifer to contact you for a brief, confidential follow-up? *

Telephone

What days and general times are typically best for Jennifer to attempt to reach you? (e.g., Weekday Mornings, Weekday Afternoons, Weekday Evenings, Specific Days) *

Almost done!

Is there anything else specific you'd like Jennifer to know before she reaches out, or any questions you have at this stage?