We’re here to help you find the right therapeutic fit.

Name *

First Name

Last Name

Client's date of birth *

MM

DD

YYYY

Phone

(###)

###

####

Preferred session format *

Virtual/Telehealth

In Person (Bellevue, WA)

I'm Flexible/No preference

Preferred time of day *

Check all that apply or that are options

Morning (8am-11am)

Midday (11am-2pm)

Afternoon (2pm-5pm)

Evening (5pm-7pm)

Flexible