Contact Me

Please fill out these forms before arrival of your first appointment. If you have any questions, you may call me, or we can discuss in person. Please do not send these forms via email or fax for privacy reasons.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Checkbox

Preferred Method of Contact

Email

Phone

Security Question: What is the opposite of down?

Phone: 513-580-8167

Fax: 513-745-965

Office Location:

OptiCARE Counseling, LLC

2619 Erie Ave

Cincinnati, Ohio 45208