Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred contact methods: *

Text

Email

Phone

When are you available for a session? (select all that apply) *

Monday (3pm, 5pm)

Tuesday (11am, 1pm, 3pm, 5pm)

Wednesday (11am, 1pm, 3pm, 5pm)

Would you like to be added to my waitlist for your preferred day and time based on cancellations? *

Yes

No

Would you like to be added to my waitlist for "next available" times based on cancellations? *

Yes

No

Considerate/Equity Pricing *

Cancer is expensive and there is no shame in the toll it takes on us, physically, mentally, emotionally, and financially. I offer discounted sessions for those who may not be able to afford the price of a full session or ongoing care on their own. My current new client and standard sessions are $125. If seeking care with me is going to create a financial strain or prevent you from scheduling please select "tell me more" and we can discuss the possibility of a discounted session (up to 50%) now or in the future. I do not require any type of "proof" but simply ask that you are honest so that those who need this type of support can receive it.

Tell me more, please.

No, thank you, I can pay in full for now.