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Individual & Family Therapy Interest Form

Thank you for reaching out.

I’m Dr. Kimberley Palmiotto, PsyD, LCPC, ATR, ABSNP. I’m a Licensed Clinical Professional Counselor, Credentialed School Psychologist, and a Registerd Art Therapist. I am also a diplomate of the Americal Board of School Neuropsychology.

My practice specializes in supporting girls and women, with particular expertise in the emotional, relational, and developmental experiences that shape girlhood, womanhood, and the relationships between mothers and daughters.

I work with individuals and families around concerns such as anxiety, emotional overwhelm, identity and self-worth, life transitions, relationship challenges, family patterns, parenting and adolescence, and mother-daughter disconnection/conflict.

My approach is relational and developmentally informed, and I often incorporate creative and expressive approaches to therapy, along with an understanding of attachment, emotional regulation, nervous-system awareness, and the ways our earlier experiences can influence how we relate to ourselves and to the people we love.

I offer individual therapy and family therapy, including specialized work with mothers and daughters who want to better understand one another, repair patterns of disconnection, and build a stronger relationship.

This short form is simply a first step. It is not a clinical intake, so you do not need to share your whole story here.

Once I receive your form, you will receive an email with a link to schedule a brief connection call with me. The call gives us an opportunity to talk a little more about what is bringing you to therapy, what you’re hoping for, and whether working together feels like a good fit.

1. Who is completing this form?

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2. Your name

3. Your email address

4. Your phone number

5. Who would therapy be for?

6. What kind of support are you interested in?

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7. What has you reaching out for support right now?

8. What are you hoping therapy might help with?

9. If you are seeking support related to your daughter, what feels most important right now?

10. Have you or your child participated in therapy before?

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11. How would you prefer to meet?

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12. What is your general availability for ongoing therapy?

13. How did you hear about Dr. Palmiotto?

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14. Is there anything else you would like me to know before we connect?

Before You Submit
Please check the box below before submitting your inquiry.