Appointment Request and Forms

To schedule an individual, children, couples, marriage or family therapy appointment or to obtain additional information about any of these counseling services, please fill out the form below or give me a call.

Your Name (required)

Your Email (required)

Your Phone Number(required)

Preferred Date and Time(required)


Your Message

Call (786)290-0935

Click to download:

Couples Information Form 

CL Authorization to Release Information

CL Authorization to Request Information

Limits of Confidentiality

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