Name *

First Name

Last Name

Phone

(###)

###

####

What services are you interested in? *

Psychotherapy | Counseling

Individual Art Therapy

EMDR

Community Art Therapy

Lecture | Workshop

I understand that individual therapy services are private pay only (with the option to seek reimbursement with a PPO plan) and take place virtually. (Community art therapy, lectures, and workshops are offered virtually AND in-person) *

Yes

No