Name *

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Last Name

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Phone Number *

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Preferred Method of Communication

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I am licensed in Pennsylvania and an approved telehealth provider in Delaware and Vermont, so services must be rendered within one of these three states. Which of these states do you live in? *

Pennsylvania

Delaware

Vermont

I am an out-of-network provider, meaning that I do not accept any insurance and clients pay me directly for sessions. For more information, please visit the FAQ section of my website. Please click the box below to acknowledge that you understand that I am not in-network with any insurance providers. *

Yes, I understand that you are not in-network with any insurance providers