CAPICmatch.org does not read or retain your e-mail. However, a copy will be sent to you for your records. Please be aware that e-mail is not a secure means of communication and spam filters may prevent your e-mail from reaching the therapist. The therapist should respond to you by e-mail, although we recommend that you follow up with a phone call. If you prefer corresponding via phone, leave your contact number.

Sending an email using this page does not guarantee that the recipient will receive, read or respond to your email.

If this is an emergency do not use this form. Call 911 or your nearest hospital.