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Debra Joy Goldman, MS, LMHC
Request An Appointment
Lake Park and Jupiter, FL

Fees 

Individual sessions $135- $150

Groups  $35-$50

Dream work: thirty minute phone consult is $40

Considering therapy? Call me for a free 15 minute phone consult. 561-247-0191


*When would you like to come in for your session?
This week or as soon as possible
Next week


*What kind of service are you seeking?
Individual (In my office)
Group
Other (Explain Below)


*First Name:

*Last Name:

*What is your age?

*What is your gender?
Male Female
*Zip Code:

*Best number to reach you:

2nd best number to reach you:

*E-Mail:

*In the space below please indicate the days and times that will work for your session and briefly describe the reason you are seeking my services:

I will carefully review your request to determine the appropriateness of my services for your needs.

By submitting this form you grant me permission to contact you by phone and/or e-mail. This form is not for use in emergency situations.






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Debra Joy Goldman, MS, LMHC
221 Greenwich Circle
Suite 100
Jupiter, FL 33458
1408 N Killian Drive
Suite 112
Lake Park, FL 33403
561-247-0191



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