In order to permit us to handle your request in an intelligent and effective way, and allow us to weed out spam or fraudulent requests, please provide the following information when submitting you request form:
The reason for your request
The best time of day and day of the week to call you for a 30min consultation at the number you provide on the form
If you are requesting a 50min video consultation, please note that it will be scheduled on the next available Friday and that you will receive the link to join the day before; our provider is Intermedia’s AnyMeeting
If you are a licensed clinician, please indicate your license number and the state where it was issued
If you work for an organization, firm, or agency, please provide the name and location of your company
To maintain confidentiality, please do not specify the name of your client or patient. Use a pseudonym if necessary. We will verify the legitimacy of all requests. If we cannot verify its legitimacy, or if your submission form is incomplete, the request will be ignored. We proceed with the call back or the video scheduling only after the payment for our services is received.