Relationship Anxiety/ROCD Interest Form Name * First Name Last Name Email * Phone * (###) ### #### Preferred Contact Method * Email Phone Call Are you looking for a provider that is IN-NETWORK* with your insurance? * Please note that my practice does NOT take insurance for group therapy services How did you hear about me? * Is there anything you'd like for me to know before I reach out to connect with you? * Thank you! You will hear from me within the next business day :)
