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 MethodEmailPhone Please list a few times that would be best for us to contact you I’m Interested In I’m Interested In Individual Therapy Couples Therapy Couples Intensive EMDR Intensive Naturopathic Medicine Acupuncture Life Coaching & Acupuncture Massage Therapy Therapy Supervision/Consultation Healing Heartbreak Workshop Other If you selected "other" please list the service your are interested in recieving Select your provider Select your providerAdriana Brandes, LMTAlice Veirs, NDEmily Burnham, LAMFTKeely Puchalski, NDKerstyn Ludlow, MFT InternNick Puchalski, LMFTTara Sorenson, LPC, LCPC, LACOther/Open Briefly describe your current needs 4 + 10 = SEND