IMPORTANT: Do not use this form for emergencies. If you are experiencing a medical or mental health emergency, or if you or someone else is in danger, please call 911 or go to the nearest emergency room immediately. You may also call or text 988 for the Suicide & Crisis Lifeline.

Privacy Notice: To protect your confidentiality, please limit the information in this form to scheduling logistics and general inquiries. Please do not include specific clinical details, trauma history, or sensitive medical information. We will discuss these details securely during our consultation or initial session.