Let’s work together

Interested in working together? Use this form to share with me a little about you and what you want to work on.

Please check my FAQs for updated information on my fees and insurance policies before completing this form to ensure that you understand my current fees and insurance policies.

Name

First Name

Last Name

Phone

(###)

###

####

Where are you located?

I am only able to provide therapeutic services to adults located in California and Ohio at this time (you can travel to me in Rancho Cucamonga, CA for Intensives).

What services are you interested in?

EMDR Intensives

Weekly Individual Therapy (*waitlist*)

Ketamine Assisted Psychotherapy (*waitlist*)

In Person Event

Virtual Event

Media Appearance/Interview

Clinical Consultation

Other

If requesting to become a client of mine, please confirm that you have reviewed my fees and insurance policies.

How did you hear about me?

Word of Mouth

Tell me more about what you want to work on.

Let’s work together

If you’d prefer, you can also reach me via email at:

hello@summerforlenza.com

Summer Forlenza, LMFT

Let’s Connect

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