Please Read: 2021 Intake & Referrals

Thank you for contacting our Practice.   We are booking new assessments for January 2022 and therapy referrals for March 2022.  If you would like to be seen at that time, please complete the intake form on our website. Dr. Pure has a number of colleagues to whom she is redirecting referrals. If you wish to have contact information for them, please let us know at intake@drpureandassociates.com

Step 1 of 4

Child / Adolescent's Given Name(Required)
Date of Birth(Required)
What is your child's identified sex(Required)
Residence(Required)

Parent Guardian Information

Parent / Guardian 1(Required)
Mailing Address if different from child's (PO Box if applicable)
Parent / Guardian 1 Email(Required)
This form is configured to send a confirmation email to this email address.

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