Briefly
describe what type of service you are interested in using
the MESSAGE section of this form. Keep it short (100 words
max), this is just an initial contact.
If you would rather be contacted by phone, please indicate
that in the message section, and leave your phone number.
Please double check your email, and phone number, if you
prefer to be called.
Please note that emails are not considered a secure means
of communication or private by HIPAA. Don’t
leave any information that you would be uncomfortable with
in the event that it was intercepted. Spam filters
may prevent your email from reaching me.
Sending an email does not guarantee that the recipient will
receive read or respond to your email.
If this is an emergency do not use this form. Call 911.
