Legal name *

First Name

Last Name

Phone number

(A number where it's ok to receive a voicemail from me)

(###)

###

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What services are you interested in? *

Individual therapy

Adjunctive EMDR (if you already have a primary therapist)

Couples/relationship therapy

Family therapy

EMDR consultation (for EMDR therapists only)

Private practice consultation (for therapists only)

How would you prefer I contact you? *

E-mail

Phone

Confirmation *

Please confirm the following to ensure a smooth process when we connect:

I have read through the FAQ section on this website.

I understand that Shelby Dwyer and Embodied Insight Counseling & Consulting LLC are out-of-network and not contracted with any insurance companies.