Request an Appointment: Individual Therapy

First Name

Last Name

Session format (check all that apply) In-person sessionsVirtual sessions

Please provide your email address. We’ll reach out to you via email as soon as a spot opens up on our waitlist. We will never share your email or use it for marketing purposes.

Phone Number

Format: 000-000-0000

May we leave a message at this number? YesNo

Please list the days and times you are consistently available for appointments.

Note: We are closed on weekends

Additional Information or Requests

Tell us anything else that might help us serve you better.

How did you hear about the Love and Money Center?

If someone else will be attending sessions with you, please include their information below.

Additional Person's Name

Additional Person's Email

Additional Person’s Relationship to You