An art studio workspace with paints, brushes, and art supplies scattered on a large wooden table, with a colorful abstract painting on the wall in the background.

A solitary hiker standing at the top of a winding trail on a mountain ridge with foggy, misty atmosphere and distant mountain peaks

You are so brave for taking the first step!

Interested in working together? Fill out some info and we will be in touch shortly! We can't wait to hear from you!

Name

First Name

Last Name

Client DOB

Please be mindful that I work with women 20yo and older

MM

DD

YYYY

Client Pronouns

ex: he/him, she/her, they/them, all pronouns

Email

Phone

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Payment

Do you plan to Self-pay or use your insurance (Please include insurance type if you would like to use it).

Session Type

Availability

Please let us know what your ideal time would be to meet. We are available Wednesday and Fridays (virtual and in-person). We will do our best to accommodate, but cannot guarantee the time you request.

Presenting Concerns

If you select "Other," please describe your presenting concern in the next box. Please also note that there are certain concerns that are out of my scope. I will email and let you know if this is the case with anything checked.

Anixety

Depression

Stress

Life transistions

Trauma

Self-esteem

Other

Reason for Seeking Counseling

Please provide a brief description of your reason for seeking counseling and why you are choosing Creative Path to Healing.

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