We look forward to connecting with you. Book an Appointment First Name Last Name Email Phone Number Age How Did You Hear About Us? How Did You Hear About Us?Google/Internet SearchGoogle MapsReferred by Medical Provider or TherapistReferred by Friend or Family MemberPsychology TodayZocDocGoogle AdInstagramFacebookOther Preferred Contact Method Preferred Contact MethodPhoneEmail Please list your preferred appointment days & times I’m Interested In I’m Interested In Individual Therapy Couples Therapy Couples Intensive Premarital Counseling EMDR Intensive Naturopathic Medicine Acupuncture Therapy Supervision/Consultation Workshop or Training Event Other If you selected "other" please list the service your are interested in recieving Select your provider Select your providerAlice Veirs, NDEmily Burnham, LAMFTKeely Puchalski, NDKerstyn Ludlow, MFT InternNick Puchalski, LMFTOther/Open Briefly describe your current needs 8 + 2 = SEND