Therapy Inquiry
This is a secure form and the best way to get in touch with me regarding starting therapy!
First Name
Last Name
Email
Phone Number
Do you have Partnership insurance?
Yes
No
What brings you to therapy at this time?
200
What days are you available for therapy?
Monday (telehealth only)
Tuesday (telehealth only)
Wednesday (telehealth or in office appointments)
Thursday (telehealth or in office appointments)
If I am unavailable would you be interested in being referred to my associate? Weiting Tiffany Chen, Associate Marriage and Family Therapist #134303 is currently under my supervision
Yes
No
Send
Powered by