Untamed Therapy & Consulting

Your info

First name

Last name

Phone

Name you go by

State

Select the state you live in

Are you 18 or older?

Yes No

Reason for care

Describe briefly what is bringing you to therapy or any questions you have.

Anything specific you want to work on? Past trauma, emotional exhaustion, patterns in relationships.

Limited to 600 characters

Which therapy service are you interested in

55-minute sessions | Weekly or Bi-weekly ($185) EMDR Therapy Intensives | 3-8 HR Packages (starting at $1,375) EMDR Intensive Programs | 8 or 16 Week (starting at $3,450) Not sure yet. Help me figure out what fits.

Untamed Therapy & Consulting is an OUT-OF-NETWORK provider.

This means you pay for services upfront and if your insurance plan includes out-of-network benefits, we'll help you submit for reimbursement through a service called Thrizer.

I understand that Untamed Therapy & Consulting does not accept insurance

Client Preferences

Preferred Method of Contact

My team will contact you here. The consult is with me.

Text Message Email Phone Call

Preferred Therapy Setting

In-Person (Office is located in Cape Coral, FL) Telehealth

Administrative

How did you hear about Untamed Therapy?

NOTE: Ongoing weekly therapy is Florida-only. EMDR Intensives are open to women who travel in to Cape Coral.

I live in Florida I live outside Florida and I'm willing to travel for an Intensive

If you live in Florida, what city do you reside in?

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.