OPTIONAL FIRST STEP

Share Brief, Non-Urgent Scheduling Preferences

This optional form helps the practice understand what you are generally seeking and how to contact you. It is not an intake evaluation, therapy, or a way to receive urgent support.

This form is not monitored continuously and is not for urgent concerns. Do not include detailed clinical history, diagnoses, records, insurance or member IDs, payment information, or anything you would not want sent through a website form. If you are in immediate danger or may harm yourself or someone else, call 911 or go to the nearest emergency department. In the United States, call or text 988.

Share only the minimum general information needed to request a consultation. Review the Privacy Policy before submitting. This optional form does not create a psychologist-patient relationship, confirm an appointment, or guarantee that services will be offered.

First name *Email *

Preferred contact methodPhone

What best describes what you are looking for? *

Choose up to three general areas. There is no need to share personal history here.

Care preferenceGeneral availability

Anything brief you would like the practice to know? (optional)0/600I understand this optional form is not monitored continuously, is not for urgent concerns, and should not include detailed health records or sensitive documents. I understand that submitting it does not create a psychologist-patient relationship, confirm an appointment, or guarantee that services will be offered. *

About this optional form

A practical first step, not an intake assessment

This optional questionnaire is designed to communicate basic scheduling preferences and broad areas you would like to discuss. It helps the practice prepare for a non-urgent consultation, but it does not collect the detail needed for psychological assessment, diagnosis, or treatment planning. You can skip the form and contact the practice directly if that feels more appropriate.

A submitted form is reviewed during normal office operations. The practice may contact you using your stated preference to share general information about current options, availability, or next steps. A response does not establish a psychologist-patient relationship, confirm an appointment, determine clinical fit, or guarantee that a service will be offered.

For your privacy, share only the minimum general information requested. Do not include medical records, detailed history, diagnostic documents, payment information, insurance identifiers, or anything you would not want to transmit through a website. Questions about privacy practices, telehealth format, fees, and possible reimbursement can be discussed before scheduling.

You remain free to decide whether to request a consultation after submitting this form. The form is meant to make a later conversation more practical; it does not create an obligation to schedule or begin services. You may withdraw from the process before scheduling. Your preference is respected.

This information is intended to support an informed, non-urgent decision about whether to explore a topic or contact the practice. It cannot account for your complete circumstances, replace a clinical conversation, or determine what service is appropriate for you.

You may take time to review the information, ask general questions, or decide that another resource or provider is a better fit. If you contact the practice, a message or consultation request does not establish a psychologist-patient relationship, confirm an appointment, or guarantee that services will be available.

Reviewing this page does not require any next step. No decision is required today.