Contact me to schedule a free 20 minute video consultation. Name * First Name Last Name Email * Phone * (###) ### #### Subject * Session location preference * In person (I live in or near Roanoke, VA) Telehealth (I live in Virginia and would like to meet remotely over video) Primary reason for seeking therapy: * Couples therapy Individual therapy for a sexual concern Other reason Please share the times you can be available to participate in therapy sessions (check all that apply): * Weekday mornings Weekday afternoons Weekday evenings Please briefly describe the concern that is causing you to seek therapy. * What are your goals for therapy? What do you hope to achieve through this process? * Please tell me how you found out about me and the services I offer (referred by someone, internet search, etc.) * Checkbox * I understand that all sessions are private pay and will not be covered or reimbursed by insurance. I am a resident of Virginia and will be located in Virginia during sessions, whether they take place in person or over telehealth. Thank you for reaching out! Unless I am out of the office, I strive to return communication within two business days.I look forward to connecting with you.Best wishes,Adrien
