Get in touch

Contact form.

I look forward to meeting you.

contact_form
Optional. I'll match whatever you give me.
A sentence or two is plenty.
Diagnoses, things you've tried, what hasn't worked. Optional.
Optional. Helpful for me.
Sliding scale is reserved for families making $70,000/yr or less.
Before we meet

Preview the intake form

The full intake questionnaire comes after we’ve booked a consultation. Here’s exactly what it asks. The more information you provide, the better I’ll understand where you are coming from. You can skip questions that you’d rather discuss in person.

01 Client information
  • Name you go by & pronouns.
  • Age & date of birth.
  • Best email and phone. Are text and/or voicemail ok?
  • Address.
  • Time zone and the windows you’re generally free.
  • An emergency contact (name and number).
02 What brings you here
  • Please tell us why you are seeking support.
  • What diagnoses have you received, at what age?
  • Possible diagnoses. Are there other diagnoses you suspect?
  • Are you on any medications related to these diagnoses? If yes, please list.
  • Strengths. What are some character traits, accomplishments, or strengths you see in yourself?
  • Interests. What do you enjoy doing, talking about, or learning about? Do you hyperfocus on anything?
  • Support network. Who do you rely on for support, and what is your relationship to them? Are you feeling isolated?
  • Sensory sensitivities. Are you hyper (over) or hypo (under) sensitive to sounds, tastes, textures, smells, or other environmental stimuli?
  • Education, elementary through high school. What was your experience like, both academically and socially? Did you graduate?
  • Work. Have you had a job? What sort(s) of work? What has gone well for you with work, and what has been challenging? What are your career goals?
  • Anything about access I should set up before we meet? (Captions, breaks, camera-off, a slower pace…)
  • Additional information. Is there anything else you’d like us to know about you?
04 Policies and rates
  • How did you hear about the practice?
  • Would you like to talk about sliding scale?
  • You will be asked to read and sign confidentiality, scope of practice, cancellation, and fee policies.