First Name*

Last Name*

Your Email*

Your Phone*

Is it okay to text you at this number?
YesNoI'm not sure yet

Select State *
--- Select Choice ---TexasNevadaIllinois

Therapeutic Request (choose from drop down menu) *
Trauma Informed TherapistEMDRSomatic ExperiencingNutrition Therapy/ Disordered Eating TreatmentADHD Accommodation (non-medication assisted)Medication management/ PsychiatristGroupsTrauma Informed Leadership Coaching/ Workshop15 minute Consultation w/ a TherapistMedia RequestHealing RetreatSomething Else

Anything else you'd like to share with us at this time? *