E-mail address (required)
Is your email address private?Check button if yes.
If it is not, how will you protect material that you want to keep private?
Are you in psychotherapy, counseling or psychiatric therapy at this time? Check button for yes
If so, please check with your practitioner to see if this adjunct work is appropriate at this time.
My practitioner does concur with my decision to Take Time For Me. check button for yes
What key changes would you like to see in your life at this time?
What questions do you have about Taking Time for Me?
When would you like to begin this process?
Would you prefer to do your free initial consultation by phone or e-mail? Phone e-mail
Dr. Firman will be in touch with you within a few days of receipt of your application