Treatment Inquiry Form

**Please note that submitting a treatment inquiry does not constitute a treatment relationship nor does it guarantee an appointment. Treatment inquiries serve to trigger a screening call. Please allow 1-2 business days for response. Sending an email using this page does not guarantee that I will receive, read or respond to your email. If this is an emergency please call 911 or go to your nearest emergency room. This contact form is not to be used for emergent requests or to seek immediate medical advice.