Name*

Email*

Phone Number*

What are you reaching out for?*

Individual Therapy

Therapy Intensives

EMDR

Anxiety / Stress

Depression

Trauma

Relationship Support

Other

Are you a new or returning client?*

New

Returning

Are you interested in in-person, telehealth, or either?*

In-Person

Telehealth

Either

Please share anything else you’d like April to know before your consultation.*

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