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First and Last Name*

Email Address*

Phone Number*

Service(s) Inquiring in CA*

Adult Individual Therapy

Child Individual Therapy

Couples Therapy

Family Therapy

My preferred method of payment would be*

Private pay (out of pocket)

Insurance: Aetna or Anthem Blue Cross California

Days and times you will be available for a 15 minute consultation*

What are the key things you'd like to work on or explore in our sessions?*

Please fill out the form below to connect

10265 Rockingham Dr Ste 100 PMB 6065

Sacramento, CA 95827-2566

In Case of a Mental Health Crisis or Emergency: Call 911 or go to the nearest hospital

The Trevor Project Hotline: Call 1-866-488-7386, text START to 678678

Suicide and Crisis Lifeline: Call or text 988