African American Couple

INTAKE APPOINTMENT REQUEST

To schedule an intake appointment or "structured playdate", or to obtain additional information about any of these services, please fill out the form below or give us a call.
 

The cost of this initial appointment is $100.00 to be paid by date of service. To make a payment click here. Intake appointments can be scheduled on most Tuesdays or Thursdays.
 
Please do not include confidential or private information in this form or any other form found on this website. This form is for general questions or messages to the practitioner. Email may contain client identifiable or confidential information. Because email is not secure, please be aware of associated risks of email transmission. Communication via email implies your agreement to accept the risks of email communication. 

 

 

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.