info@eastsidetherapyla.com(818) 515-14311910 W Sunset Blvd. Suite 440Los Angeles, CA 90026 CONTACT US Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth MM DD YYYY Gender Pronouns Please describe the issue(s) that bring you to therapy Please select any topics that might be relevant to you. Eating Disorders Body Image Depression Anxiety Perinatal Mental Health Sex Positive/Kink Allied LGBTQIA+ Affirming Care Executive Functioning Peer Relationships Stress ADHD Autism Social Anxiety Relationships Substance Use Women's Issues Religious Trauma Life Transitions Grief & Loss Career Counseling Work-life Balance Creativity Entertainment Industry Professionals Parenting Self Esteem EDMR Chronic Pain or Illness Cultural Identity OCD Panic Attacks Suicidal Ideation Trauma, Complex Trauma, & PTSD Sexuality Please select the days and times that you would be available for sessions Monday Morning Afternoon Evenings Tuesday Morning Afternoon Evenings Wednesday Morning Afternoon Evenings Thursday Morning Afternoon Evenings Friday Morning Afternoon Evenings Saturday Morning Afternoon Evenings Sunday Morning Afternoon Evenings Session Preferences * Service Individual Therapy Couple's Therapy Family Therapy Child/Adolescent/Teen Therapy Group Therapy EDMR Coaching Other * Location Virtual In-Person No Preference * Therapist Any Becca Hansel Amanda Wheeler Erin Weston Finley Woodmansee Mary Robinson Kate Behzadi I'm not sure Consultation Call Please list a few days/times you are available for a complimentary 15-minute consultation call. Referral Source How did you find us? Family or Friend Another Provider Psychology Today Google Instagram Facebook Other Thank you! We will be in touch shortly to get you scheduled.
