Appointment Request

Please complete the form below to schedule an appointment. I will do my best to accommodate your request.

Two Dried Leaves

Preferred Date and Time

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Growth Peak Counseling, LLC harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Thank you for your request! I will contact you soon.