To schedule an initial consultation, please complete, filling in all the requested information, and then submit this form. Dr. Haley will get back to you by email as soon as she can. Please note that due to time constraints, Dr. Haley can only respond to you by email so please be sure that your email address is entered correctly.
Please note that the Initial Consultation is a full session in which your problems are assessed, a diagnosis is determined and initial treatment plans are formulated. It also gives us the opportunity to evaluate our ability to work together.
During the pandemic, to ensure our safety, all sessions will be held remotely by video.
If you do not plan to use health insurance to help pay your fees, skip this section. Otherwise, please answer the following:
As a sole practitioner with no staff, Dr. Haley uses email for almost all communications outside of sessions. Emails from Dr. Haley are essentially confined to matters such as fees, scheduling, and insurance coverage. She does not send emails containing personal information such as diagnosis, treatment or issues discussed.
Most email services do not utilize encrypted email. This means that, although unlikely, a third party might be able to access our email communications and read them. Federal Guideline require that you consent to the use of email for communicating health information in order for it to be used.
** Please check to ensure that you have provided your correct email address in the space provided AND have checked the box above giving permission to email communications. Due to time constraints and frustration with tag-telephone, Dr. Haley can only respond to you by email. **
Okay, now, click the send button below and you will be contacted via email, usually by the weekend following receipt of this form, about scheduling a meeting with Dr. Haley.
Please be patient and wait until you arrive at the "thank you" page before leaving this page. Otherwise, your form will not be transmitted. Thanks.