General 1 — From Here to There.....

pamelaspallaccilmft@gmail.com
(585)-402-1755

25 Canterbury Road, Suite #311
Rochester, NY 14607

Name

First Name

Last Name

Email

Phone

(###)

###

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What services are you interested in?

Individual Therapy

Couples Therapy

Family Therapy

ADHD Psycho-educational Individual Therapy

ADHD Couples Therapy

ADHD Family Therapy

Workplace -Focused ADHD Therapy

College and Graduate School Focused ADHD Therapy

Other

Message

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Pam Spallacci, LMFT harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

I look forward to hearing from you.