Contact — Co-Creative Therapy and Consultation

Please use the form to set up a free 15-minute consultation. Filling out this form does not guarantee that you will receive services from Co-Creative Therapy. This will help us decide if I’m the right fit for your therapeutic goals. During the call, we’ll discuss what’s bringing you to therapy and I’ll address any questions you might have. If after the call we decide to begin therapy, I’ll lead you through the next steps in setting up your introductory session!

Name

First Name

Last Name

Email

Phone

(###)

###

####

Preferred way of contact:

Email

Phone

(###)

###

####

Age

16-26

27-37

38-50

50+

Referral source?

Direct search

Psychology Today

Web search

Other

Brief Description of why you are interested in therapy. What bring you here?

Scheduling availability

Acknowledge

Please acknowledge that I am only taking Premera and Lifewise insurance at this time. For other insurance policies I can offer a superbill for insurance reimbursement, I charge a private pay fee. My fees start at $150 dollars.