Contact page Name * First Name Last Name Preferred name, if different than above Date of Birth (for identification only) * MM DD YYYY Gender (for identification only) * Male Female M to F transgender F to M transgender Gender non-conforming Phone (where I can call you back) * (###) ### #### Is it okay to email you or leave a message at this number? * Yes No Email * Briefly describe your reason for seeking treatment. * I am looking for: therapy only therapy, combined with medication management unsure Payment will be processed either through insurance coverage or via out-of-network agreements. Please furnish the necessary details for the chosen method. * Privacy notice * Please be advised that the information submitted through this form will be sent to Dr. Weeks' email account, which uses industry-standard 128-bit encryption. Unfortunately, all email carries some risk of interception and therefore the security and confidentiality of email communication cannot be fully guaranteed. I understand the privacy limitations of email communication. Thank you! I will contact you via email or call you within 2 to 4 business days.