Client Booking Form

Holistic Therapy-as of 6/2/22 I am not accepting new clients at this time and I do not keep a waitlist. I recommend two colleagues:
https://www.psychologytoday.com/us/therapists/simone-mcnamer-underhill-vt/933704
https://www.psychologytoday.com/us/therapists/steven-lilly-underhill-vt/911768

Consult and Booking Form.
Please note I only accept Private Pay Clients ($120/50 minute session) BCBSVT, Medicaid or Sliding Scale

* Indicates required field

Name *

First

Last

Email *

Why are you seeking therapy at the moment? What are your goals? What is your payment method? *

Are you on any medication, if so for what? Do you have a history or current thoughts of self harm, suicide or harm to others? *

Have you seen a therapist before? If so, explain. *

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