Let’s work together Complete this form to get started on your healing and wellness journey Name * First Name Last Name Email * Phone (###) ### #### What services are you interested in? Free 15-minute clinical consultation with a licensed psychologist Scheduling an intake appointment to begin individual therapy Professional Consultation Mediation Services How did you hear of us? * Personal Referral Professional Recommendation from my Veterinarian Association for Pet Loss & Bereavement (APLB) Directory Pet Loss Support Group Referral Internet Other Message * Acknowledgment: * I understand completion of this form for communication purposes with the Practice does not constitute a doctor-client relationship. Yes, I understand. Thank you! We will be in touch shortly.
