If you would like me to contact you when a sliding scale appointment becomes available, please fill out the following form. If your situation should change, you can fill out the form again to update your information and you will not lose your place on the list. I am the only one sees the information you provide and it will be kept completely confidential. If you would prefer to communicate this information to me via phone, please call me at 917-675-3446.

    *People who are sex workers and/or have multiple marginalized identities are given priority for sliding scale appointments.
  • This field is for validation purposes and should be left unchanged.