Request for Consultation

Type of consultation requested:

In Office   Telephone Call
  Preferred method of contact: TelephoneEmail

First Name:  Last Name:  E-Mail: Telephone:

Please enter one primary and two alternate dates and times for your consultation. We will email or call you within 24 hours to confirm your appointment. We will contact you using the telephone number and/or email address you provided above. Please be sure that the number or email is secure.

Primary:   Alternate 1:  Alternate 2:    

Please give us a few details about your situation

Telephone consultations:
We will attempt to contact you at the number provided at the time you have requested and that we have confirmed with you by email. If there is no answer we will repeat the attempt at 5 minute intervals for 30 minutes. Calls not answered after that time will be considered missed appointments.

Office consultations:
Please be on time for your appointment. Appointments will be considered missed after 30 minutes.

Consultation fee is $225.00. Payment is due in advance. Clicking "submit" will redirect you to PAYPAL. We will email with confirmation of your appointment within 24 hours.