Are you ready to start feeling better?

Fill out this quick, confidential form to find out if EMDR therapy could help:

Client's Name *

Client's Name

First Name

Last Name

Client Phone (18 and older)

(###)

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Client email (18 and older)

Parent Name (if minor)

First Name

Last Name

Parent Email Address (if minor)

Parent Phone (if minor)

(###)

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Client Age *

What is your teen's (or your) biggest challenge right now?

What is your biggest challenge as a parent (if applicable)?

What would you like to see your teen (or yourself) accomplish in treatment that would make you feel like it was worth the investment?

What have you tried so far?

Is there anything else that you think would be helpful for us to know before connecting for a call?

I will be in touch soon!