Client Application

Please select who is coming to therapy, and then fill out the below info so that I can get a quick snapshot of what you’re looking for. I request this info because I respect your dedicated search for a new therapist. I want to ensure that we will be a perfect match so that I can be confident I can provide the best level of care.

New Client Application for Individuals

Full Name:

First Name

Last Name

Age:

Phone:

(###)

###

####

Okay to text/leave a voicemail?

Email:

Preferred contact method:

Best time to contact:

Have you been to therapy before?

Main presenting problem?

If you select "Other" please describe below

Other:

Have you recently been hospitalized/admitted for a severe mental health crisis?

If yes, how long ago?

Are you currently experiencing suicidal ideation/thoughts of self-harm?

If yes, how often?

New Client Application for Couples

Full Name:

First Name

Last Name

Full Name of Spouse/Partner:

First Name

Last Name

Age:

Age of Spouse/Partner:

Phone:

(###)

###

####

Okay to text/leave a voicemail?

Email:

Preferred contact method:

Best time to contact:

Have you been to couple's therapy before?

If yes, when?

Main presenting problem?

If you select "Other" please describe below

Other:

Have either of you been hospitalized/admitted for a severe mental health crisis recently?

If yes, how long ago?

Are either one of you experiencing suicidal ideation or thoughts of self-harm?

If yes, how often?

New Client Application for Families

Full Name:

First Name

Last Name

Full Name of Spouse/Partner:

First Name

Last Name

Age:

Age of Spouse/Partner:

Full Names and Ages of Children:

Phone:

(###)

###

####

Okay to text/leave a voicemail?

Email:

Preferred contact method:

Best time to contact:

Have you been to family therapy before?

If yes, when?

Main presenting problem?

If you select "Other" please describe below

Other:

Has anyone recently been hospitalized/admitted for a severe mental health crisis?

If yes, please explain which family member and how long ago:

Please indicate how long ago 1. 1 - 3 weeks ago 2. 1 - 5 months ago 3. 6 months - 1 year ago 4. Several years ago

Is anyone in the family experiencing suicidal ideation or thoughts of self-harm?

If yes, please explain which family member(s) and how often:

Please indicate 1. Everyday 2. Most days 3. Occasionally 4. Sometimes/Not Often

Frequently Asked Questions

Photo of brightly lit interior of therapist's office space

I am unable to accept insurance at this time. Sessions are currently private pay only: $50/hr for individuals, $100/hr for couples, and $150 for families. I accept all major credit/debit cards, as well as HSA and FSA cards. I am happy to send you monthly superbills that you can provide to your insurance plan for reimbursement. We can discuss sliding scale fees if you have concerns about payment. I am more than willing to meet your needs in any way I can!
I do in-person sessions at my office located in Corporate Woods at 8717 W 110th St, Ste 640, Overland Park, KS. (You will see it listed as “Monarch” in the hallway!) I use Sessions Health for virtual sessions, which is a secure, HIPAA-compliant platform that protects your privacy.
My specialty is working with clients who struggle with body image, disordered eating, and/or body dysmorphia, as well as anxiety, depression, trauma and life transitions. I am a Certified Clinical Trauma Professional (CCTP).

Still have questions?

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NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.