Consultation Request

Complete and submit this request form to be redirected to our booking calendar to choose the time and date of your consultation.

Consultation Request

Why we ask you to complete this form:

This questionnaire allows us to securely gather information so that our concierge can help you in the most efficient and sensitive way possible during your consultation. A professional therapeutic relationship is most effective when it is a mutual fit, and your responses will assist us in determining if and how we can best meet your needs.


Upon submitting this form, you will be redirected to our booking calendar where you may schedule your consultation at your convenience.

Scheduling an initial consultation with Repose (owned and operated by Mary Breen LCSW PLLC) and completing the necessary documentation for this consultation does not establish a professional nor therapeutic relationship and is not intended to be a substitute for professional services.

Before we get started, please agree to our terms and conditions..