NOTE: Due to the volume of applications, please do not fill out this form if your child is under 12 years old, as Dr. Z currently sees tweens and teens. Please also
note that Dr. Z only sees pain and illness cases, and that her practice is currently full with a waitlist. There is no way to know exactly how quickly or slowly this WL will move. If you need to
be seen by a CBT provider sooner, please see this list for local referrals.