Interested in Therapy?

Please fill this form out before scheduling an intake appointment. I do not currently take insurance, which means I only accept self-pay clients. I list my prices to be transparent. I am also currently only providing telehealth therapy with the expectation of incorporating in-person options in the future.

The Info

Your Name

Legal First + Last Name

Pronouns

Phone

Date of Birth

Month

Day

Year

What state do you currently live in?

How did you hear about me?

I agree to receive emails from Philly Therapy Space

Yes

Therapy

What type of therapy are you looking for?

Telehealth Therapy

Currently, the only option I am able to offer is telehealth. In the future I hope to offer a mix of in-person and telehealth. If you want to be added to the waitlist for in-person, please select the in-person option below.

Payment Options

Individual Sessions are $120

Family Sessions are $150

Groups are $250 for 5/6 group sessions (due at the start of group)

Venmo, PayPal, CC

More About You

What brings you to therapy?

This can be helpful to make sure I'm a good fit for what you seek support with.

Have you been in therapy or any sort of mental health treatment in the past few years?

This helps me to understand where you've been on your journey

What are you looking for in a therapist?

For example, you might be looking for a therapist who shares certain identities or experiences. You might also know certain approaches that are helpful for you. Or you might be looking to make sure you have a therapist who has expereince with certain diagnosis.

Your Identities

If you feel comfortable sharing here, I would love to know more about your identities as affirming identities is deeply rooted in the work I do

Racial Identity

Sexual Identity

Gender Identity

Are there other identities you'd like to share?

The Logistics

Your Availability

Please list when you're available for a 50-minute session. Be as specific as possible. I do have very limited availability and my availablity is subject to change.