CONTACT TANA: Consultations, Appointments, and Questions

Name *

First Name

Last Name

Phone

(###)

###

####

What prompted you to contact me? *

I'd like to schedule a free 15-min phone consultation

I have a question about your services.

I'm seeking services for myself.

I'm seeking services for someone else (ie: friend, family member).

Other (please describe)

Preferred Location *

In-person/Temecula Office

Virtual

First available or No preference

Availability Inquiry *

Sessions are conducted between 9 AM and 3 PM, Monday through Friday. The latest appointment available each day starts at 3 PM, unless otherwise arranged in advance. Please confirm your availability during these hours.

Yes

No

Fee Disclosure *

Fee Acknowledgement (required): While I don’t accept insurance, I do offer Superbills and partner with Thrizer, a platform that seamlessly helps navigate out-of-network therapy to save time and money on reimbursement. My session fee is $190 for a 50 min session.

I acknowledge

How did you find me? *

Referral source

Friend or Family Member

Social Media

Internet Search

Chat GPT Search

Other

Please note, submission of this contact form is for initial contact only and does not establish a therapist-client relationship. If you are experiencing a mental health or medical emergency please do not wait for a response and instead call 911 or go to your nearest emergency room. *

I acknowledge and agree to the above statement

By submitting this form, I acknowledge that I have read and agree to the Privacy Policy. I also consent to the use of my provided information for initial contact purposes *

I acknowledge and consent.