Your Name (required) Your Email (required) Your Phone Number Three main concerns for which you’re seeking therapy or spiritual direction. I am looking to have therapy covered by benefits. yesnoIf possible, but not required *All clients must check with their benefits provider directly on the exact credentials required in order to be covered. I am hoping to qualify for sliding scale fees? yesnoIf possible, but not required Did you have a particular Therapist in mind?Jennifer Dawn Watts, MANatasha Karim, MACarol Wilson, MACathy McCurdy, MA RSWJenn Betts, MAErika Dawn MohleRobyn ManzanoKhobi Attai, MAKaylee Garside, MASoonest AvailableN/A Days/Times Available: Weekday Daytime Evening Saturday All of The Above Comments on Availability: Book an Appointment or Start with a 20 Minute Consult: I would like to start with a free 20 minute consult to get to know my therapist & their approach to treatment I would like to get started on treatment as soon as possible with a full one hour appointment Anything else you’d like us to know? Please select a therapist to submit this form to:Jennifer Dawn Watts, MANatasha Karim, MACarol Wilson, MACathy McCurdy, MA RSWAllison Crosby, M.Ed.Jenn Betts, MAErika Dawn Mohle Please select a therapist to send this form to, click Send and wait for the “Your Message Was Sent Successfully” message to show up beside the Send button. This will ensure we receive your form. Thanks!