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Intake Session Request
For Romantic Partners
Name(s) and Pronouns
Phone
Email
Name(s) and Pronouns #3
Therapy Models
Intimacy From The Inside Out (IFIO/Relational IFS)
Internal Family Systems (IFS)
Ecotherapy
Hakomi Body Inclusive Therapy
Psychedelic Harm Reduction & Integration
Name(s) and Pronouns #2
Phone #2
Email #2
How did you find out about me?
Days Available
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Times
9am to 12pm
12pm to 3pm
3pm to 6pm
Flexible
Location
In Person
Telehealth
Comments: (No Personal Identifiable Information)
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