Appointment Request

If you would like to schedule a session, please fill out this form and in "notes" let me know:

1. what days and times you would prefer

2. if you'd prefer in-person or virtual sessions. 

3. if you'd prefer text or email response

4. your insurance if applicable, or if you'll be self-pay

5. *optional*  one or two words to describe why you are seeking therapy (example: "betrayal trauma" or "postpartum" )

*Please do not share your private health information on this form.

Messaging Terms & Conditions:

You agree to receive informational messages (appointment reminders, account notifications, etc.) from Aspenglow Wellness. Message frequency varies. Message and data rates may apply. For help, reply HELP or email us at [email protected]. You can opt out at any time by replying STOP.

Mobile SMS Messaging Privacy Policy:

Information collected:

We may collect Information, such as name, phone number, and email address.

Use of information collected:

We may use the information we collect to perform the services requested including billing, customer service, appointment reminders and other administrative requests.

Sharing of information collected:

We may share information we collect with payment processors, legal authorities, partners so that these service providers can perform their normal duties. We do not share, sell, rent, or trade any information provided with third parties for promotional purposes.

As a current or prospective customer, you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help.

You understand that the messaging frequency may vary. Messaging & data rates may apply.

Your mobile information will not be shared with any third parties/affiliates for marketing/promotional purposes. All policies are followed as per CIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.