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Join date: Sep 20, 2024

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Rachel Baumann

Rachel Baumann

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Tel: 203-533-1252

Email: fairfieldtherapy@gmail.com

Currently accepting new evaluations for children, teens, & adults

Will this consult be for you or are you making a referral for someone else?*

Myself

My child

I am making a referral for someone

First name

Last name*

Email*

Phone*

May I send you emails?*

Yes

No

May I call/text you with the number you provided?*

Yes

No

Client Information

If you are not the client, please answer the questions below regarding the client. I will be in touch with you soon via email to schedule your free 15 minute consultation.

Preferred Pronouns *

What is the name(s) and age(s) of the person seeking an evaluation?*

What service(s) are you seeking?*

Comprehensive Evaluation

Other

Is there anything else you would like me to know before our initial consultation?

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