Still have questions?

Important Privacy & Security Notice

Your privacy is important to me, so this form is intended for general inquiries regarding the scope of the practice and scheduling logistics (Name, Contact Info).

• What types of things are okay to ask: It is entirely appropriate to ask general questions about the types of conditions we treat or the services we provide (e.g., "Do you treat adult ADHD?" or "Do you offer medication management?").

• What to avoid: To protect your privacy, please do not include personal medical history, specific symptoms, or detailed clinical details in this form.

By submitting this form, you acknowledge that standard internet communication is not fully encrypted. Full, HIPAA-compliant clinical intake paperwork will be provided through a secure patient portal prior to your first official appointment. If you are experiencing a mental health emergency, do not use this form—please call 911 or call/text 988 immediately.