Consultation Intake Form

Please read our informed consent document prior to completing intake. The purpose of this intake is to make the most of our 1 hour consultation. Please share freely and honestly- as it is all used towards ensuring you have the best experience.  Following the form is a scheduling tool so you can set your appointment time up online as well.  Initial consultations are free, but we will charge a $35 rescheduling fee if you cancel or need to reschedule without at least 24 hours notice.  Thank you for your interest and we look forward to meeting you!

Name *
Cell Number *
Cell Number
See Funding Overview Page
Day(s) you are available to meet *
We will schedule according to our mutual availability
Preferred window of time *