Please share information about yourself using the form below. This could help me prepare to our meeting.
Information about the Client/Patient
If you are scheduled for a consultation please note that it could last from 90 to 120 minutes, after that an average session is 55 minutes.
All information that is being exchanged during our sessions and via this website is kept confidential.
Information about a Client/Patient
1. General information about You
2. Chief Complaints
Reasons for your issues
In your opinion, what is the reason you are scheduling this appointment
3. Problem History
4. Psychological Help
5. Personal and Social History
6. General Physical Health
By pressing the "Send" button you agree with our Confidential Policy
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