Scheduling an appointment

Hello! Thank you for your interest in my services. Please double check that the email address you enter is correct. If you don't receive a reply from me within 5 business days, please contact me directly (, +79629173269)
Your name
Your Email
You phone
How old are you?
Is this your first time seeking psychotherapy? If you have been to therapy before, when was the last time you went, how long did you go for and what was the modality (if you have that information)?
Briefly describe the problem or problems you are seeking help with.
Have you been to a psychiatrist before or are you seeing one now? If no, do you think you need to do so?
How did you find out about my practice (internet, friends, your doctor, etc.)?
Is there anything else I need to know about you before our first meeting?
By submitting this form you agree to the storage and processing of your personal information.