Therapy & Professional Consultation Inquiry Forms

I am honored and also excited to learn more about your commitments towards yourself and your work - along with the areas you are seeking professional support.

Kindly fill out the one of my inquiry forms below to get started and I will be in touch with you soon.

START YOUR INQUIRY PROCESS FOR THERAPY:

When completing your therapy inquiry form, please make sure to complete all the questions in order for your request to be accepted. If you have any problems with this inquiry form, please email [email protected] and you will receive a follow-up email.

With gratitude – Rebecca

First + Last Name

Phone Number

What are the best days and times for you to meet for therapy?

Where in your life and and work do you feel overwhelmed, out of alignment, or like you are hitting a wall? Please be as detailed as possible and add any areas of focus you are particularly motivated to focus on in our work together.

What kind of insurance do you have, HMO or PPO? Note: I am an out-of-network provider and can offer a super bill for those who have PPO insurance so you can get reimbursed directly from your insurance company. For your own planning purposes (I don't need this information) you will want to find out your deductible, how much has been met, and what percentage of the fee they generally cover. Please share any additional insurance questions you have below.

If you live in San Diego, what part of town do you live in?

If you live outside of San Diego, what city in California do you live in? Note: I am only licensed to see those who live within the State of California.

In the case that Rebecca is unavailable, she will put you in touch with someone from her extensive referral network. Do you have a preference for a male, female therapist?

GDPR Agreement (I consent to having this website store my submitted information so they can respond to my inquiry).

START YOUR INQUIRY PROCESS FOR PROFESSIONAL CONSULTATIONS:

I am honored and also excited to learn more about your goals and areas you are seeking professional support. When completing your consultation inquiry form, please make sure to check which type of consultation you are seeking and also make sure to complete all the questions in order for your consultation request to be accepted. If you have any problems with this inquiry form, please email [email protected] and you will receive a follow-up email soon. With gratitude – Rebecca

I am honored and also excited to learn more about your commitments towards yourself and your work - along with the areas you are seeking professional support.

START YOUR INQUIRY PROCESS FOR THERAPY:

START YOUR INQUIRY PROCESS FOR PROFESSIONAL CONSULTATIONS:

If you are outside of California and are interested in Trauma-Informed Leadership coaching, you can book a connection call by clicking here.

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