Work with Sierra

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First Name

Last Name

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Date of Birth *

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Preferred Appointment Day and Time *

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Weekdays 8am-11am

Weekdays 2pm-5pm

Reasons for Appointment *

Please check all that apply. If you do not see your reason for attending therapy listed, or want to expand on any of the items listed, please do so below in the message box.

Life Transitions

Anxiety

Grief

Body Image

Depression

Identity Development

Women's Issues

Relationship Issues

Self-Esteem

Stress Management

Infertility

LGBTQ+

Coping Skills

Other