Appointment Waitlist
Please complete this form to join our waitlist. We will reach out via email as soon as your preferred clinician has availability to see new clients.
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
What is the best way to contact you about appointment availability?
*
Text message
Email
Phone call
Are you interested in individual sessions, or couples(+) sessions?
*
Individual therapy
Couples therapy
Please select any/all clinician(s) you would be interested in seeing for individual therapy. More info here: www.clesexandintimacycounseling.com/clinicians
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First available (shortest wait time)
Meg Bauhof
Jillian DeCarlo
Ash Eging (telehealth only)
Adele Frankel
Brielle Giomini
Z Green
Jamie Greenwolf
Brenna Kegg
Candice Lawrence (telehealth only)
Evyn Lewis (telehealth only)
Linda Marcel-Rene
Sam Miller
Corinne Orr
Kat Rodgers
Kate Shaver
Asher Sovereign (telehealth only)
Jared Sparks
Sara Tilisky
Alexus Tuel
Angelica Washington (telehealth only)
Carmen Williams (telehealth only)
Please select any/all clinician(s) you would be interested in seeing for couples therapy. More info here: www.clesexandintimacycounseling.com/clinicians
*
First available in person (shorter wait time)
First available telehealth (shortest wait time)
Meg Bauhof
Jillian DeCarlo
Ash Eging (telehealth only)
Brielle Giomini
Z Green
Jamie Greenwolf
Linda Marcel-Rene
Brenna Kegg
Sam Miller
Corinne Orr
Kat Rodgers
Kate Shaver
Asher Soveriegn (telehealth only)
Jared Sparks
Sara Tilisky
Alexus Tuel
Carmen Williams (telehealth only)
Partner(s) Name
First & Last
Have you had an appointment with a clinician at CSIC in the past?
Yes
No
Have you or your partner(s) had an appointment with a clinician at CSIC in the past?
Yes
No
When are you generally available for appointments? (select all that apply)
Weekdays - daytime
Weekdays - evenings
Weekends
Were you referred to CSIC? If so, by who?
Anything else you'd like us to know:
Submit
Should be Empty: