Contact

Schedule an Intake

If you are interested in being seen either for psychotherapy or participating in a psychological evaluation, please either reach out to us over the phone, send us an email, or complete this form. In your outreach, please do let us know if you are interested in one, or both, types of service. Of note, we can only provide psychotherapy to adults. Psychological evaluations are available for individuals ages 8 through 55. We are not currently accepting new therapy clients.

As a small practice that operates without administrative support, please be aware that it may take time for one of our psychologists to get in touch with you to arrange your intake session.

We understand the importance of privacy and confidentiality. Rest assured that any information you share with us will be treated with the utmost confidentiality and handled in accordance with professional and legal guidelines.

Providers: Please use the provider referral form.

Client's Legal Name

First Name

Last Name

Client's Preferred Name

First Name

Last Name

Client's Pronouns

Client's Gender Identity

Client's Assigned Sex at Birth

Client's Age

must be between the ages of 8-55 for testing; 18+ for psychotherapy

Parent/ Guardian #1 Name

First Name

Last Name

Parent/ Guardian #2 Name

First Name

Last Name

Parent/ Guardian #3 Name

First Name

Last Name

Parent/ Guardian #4 Name

First Name

Last Name

best email to reach the Client (if they are 18 or older) or the parent/ guardian

Phone

Best number to reach the Client (if they are 18 or older) or the parent/ guardian

(###)

###

####

Is it okay to leave a detailed voicemail?

Yes

Insurance

Do you plan to use insurance to cover services?

Yes

Insurance

What insurance do you have?

Reason for Referral

Provide a brief description of why you are seeking our services at this time.

What services are you seeking?

Psychotherapy (w/ Dr. Gillian Woldorf) - Not accepting new therapy clients

Psychological Assessment

Preference

If seeking a psychological assessment, do you have a preference who you see?

Schedule an Intake

Providers: Please use the provider referral form.

Location

Hours