New Client Intake Form

Please take a moment to fill out the form below. The more information you provide, the better we will be prepared to offer effective solutions.

Any and all information submitted below will be held in the strictest confidence and will never be shared or sold with any third party. We hold discretion above all and will guard your information with integrity and diligence.  We guarantee confidentiality.

All submissions will be answered within a 24-hour period, unless a previous appointment has already been scheduled.  If you note a higher urgency to your needs, we will contact you as soon as we are in a safe place to do so and give you our undivided attention.