Let’s Get In TouchPlease fill out the form below and we will be in touch to schedule a consultation call. Name * First Name Last Name Pronouns (of person completing this form) Client's Age Client's Pronouns (if you are not the client) Email * Phone (###) ### #### What services are you interested in? Therapy Speaking Event Supervision or Consultation How did you hear about Tides Emotional Health? Message * Out-of-Network Acknowledgement * I understand that Tides Emotional Health is an out-of-network provider. Following appointments, I can be provided with a superbill which I can submit to my insurance, if desired. *For more information, please refer to the Info & FAQs page. Thank you!