Contact Me for therapy in San Rafael, CA

Hello! This form will take you to my online Initial Consultation Scheduler.

Before you take the time to complete this form, you should know that I only work with clients who want to engage in therapy on a weekly basis, not less frequently (see exceptions in pull-down menu). Is this aligned with what you're looking for?

1. First Name

2. Last Name

3. What health insurance do you have?

Note: I am in-network with two health care plans: Partnership Health Plan and Alameda Alliance for Health. Currently all my Partnership slots are FULL.

For other insurance plans, ask me about how to use your out of network benefits.

4. Do you have Medicare?

I am not a Medicare provider. Medicare recipents who work with me are not eligible for any Medicare reimbursment.

5. E-mail Address

6. Phone Number

Area CodePhone Number

7. Were you referred by your employer's EAP program?

8. Your state of residence (choose one):

9. Do you prefer video or in-person visits? (if you're ok with either, please check both)

11. How did you find me? (Please include Google/ AI search terms used, if you remember - thanks!)

12. Any comments or basic logistical questions you have? (optional)...