get started

if you are struggling or feel overwhelmed and don’t know where to start, you are in the right place. filling out this form is the first step toward finding some relief. I am a gender affirming therapist and my office is a safe space for the LGTBQIA+ community.

Name

First Name

Last Name

Preferred Name

What would you like to be called?

Pronouns

Phone

(###)

###

####

Are you looking for in person or virtual therapy?

In person at the office