New Clients

Interested in working together? Fill out this form and I’ll respond within 48 business hours. I can't wait to hear from you!

Legal Name

First Name

Last Name

Name

(I want to be addressed as? You can leave this blank if you go by your name given at birth.)

My Pronouns are

Email

Phone

(Our communication will be through email, initially.)

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Insurance or Private (Cash) Pay?

Please read Insurance + Rates + Information page for details. If you are using insurance- please verify your coverage and copay before messaging!

Message

Briefly explain why you are seeking therapy and some dates/times that work for you. (ex: mornings, Tuesday afternoon) Flexibility is appreciated and will get you on my schedule easier!

How did you hear about Enlightened Roots?