Appointment Request


To schedule a telebehavioral health - video or telephone - appointment, or to obtain additional information on my services, please fill out the form below or give me a call. My practice number is (510) 987-8448. My e-mail address is: 

[email protected]

Forms and instructions will be emailed from SimplePractice. 


If you're a new client, the following forms will be emailed to you, with instructions, through Simple Practice, a HIPPA compliant practice tool. The forms will need to be completed prior to the first telebehavioral health visit. Based on each client's situation, additional forms may be emailed to you. 

If you have been seeing a mental health provider, or determine the importance of coordinating my care with another provider (for example, your psychiatrist, primary care physician, and so on), a release of information form will also be emailed to you via Simple Practice, to authorize release of psychotherapy information.

Note: To download Adobe Acrobat Reader for free, Click here.

I am committed to your privacy. Please, do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages.

Appointment Request

Private Practice Office

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