Contact GabrielaTo contact Gabriela, use the contact form below that best corresponds with your inquiry. Public Speaking, Training, and Consulting Speaking Inquiry Form Public Speaking Full Name * First Name Last Name Pronouns * Email * Organization Your Role Phone (###) ### #### Website What are your goals in seeking my services? What kind of service are you seeking? Public speaking (e.g. keynote, panel, media appearance, etc.) Training (e.g. workshop, lecture, etc.) Organizational consultation (e.g. quality improvement, change management, leadership coaching, etc.) Desired topic(s), learning objectives, and/or consultation goals Estimated session or project length Desired Date(s) or Timeline Virtual or in-person? Virtual In-Person Proposed Budget (including travel, if in-person) Thank you! Clinical Supervision and Consultation Supervision Form Supervision Full Name * First Name Last Name Pronouns * Organization (if applicable) Email * Phone (###) ### #### Is it okay to leave a message at that number, if applicable? Yes No Are you seeking: ongoing clinical supervision (regularly scheduled sessions) consultation (as needed, possibly one session) Are you seeking clinical supervision or consultation for: As an individual For your organization What are your goals for clinical supervision or consultation? What is your proposed budget? How did you hear about my practice? This website Psychology Today Insurance Provider Search Referral Social media Word of mouth Thank you! Individual Therapy Individual Therapy Therapy Inquiry Full Name * First Name Last Name Pronouns * Email * Phone (###) ### #### Is it okay to leave a message at that number, if applicable? Yes No What brings you to therapy? What kind of therapy are you interested in? (checklist) Supplemental therapy to enhance my existing talk therapy addressing trauma Brief therapy (3-6 months) Ongoing or longer-term therapy Unsure Insurance or Self-Pay? Self Pay Insurance How did you hear about my practice? This website Psychology Today Insurance Provider Search Referral Social media Word of mouth Please proceed with submitting your form if you can answer yes to each item below: I currently reside in Illinois I am interested in telehealth (virtual) therapy Thank you!
