Kathy Engel, Psy.D. - Specializing in Treatment of Children, Adolescents, and Families

APPOINTMENT REQUEST
Parent Name:
E-Mail:
Phone Number:
Child Name:
Child Age:
Primary Concerns:
Anxiety
Depressed Mood
Anger
Aggressive Behavior
Noncompliance
Attention Deficit
Hyperactivity
Academic Underachievement
Adjustment to Divorce
Adjustment to Stressor or Trauma
Grief
Peer Relationship Difficulties
Problems with Eating
Sleep Disturbance
Other
Additional Information (Optional):
Insurance Company:
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