Appointment Request and Forms

To schedule an individual, children, couples, marriage or family therapy appointment or to obtain additional information about any of these counseling services, please fill out the form below or give me a call.

    Your Name (required)

    Your Email (required)

    Your Phone Number(required)

    Preferred Date and Time(required)


    Your Message

    Call [telnumlink](305)800-3699[/telnumlink]

    Click to download:

    Couples Information Form 

    CL Authorization to Release Information

    CL Authorization to Request Information

    Limits of Confidentiality

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