“Our society should not be one in which some children and families are more deserving of basic human rights than others.” — Dr. Suzan Song, The Hill Let’s connect. General Inquiry General Inquiry Name * First Name Last Name Email * Company Name Subject * Message * Thank you for connecting! Patient Inquiry Patient Form Join the waitlist Dr. Song is currently offering remote-only services. Are you looking for child, adolescent, or adult services? Therapy and/ or medication support? Name First Name Last Name Email What would you like support with? Please describe your past mental health treatment Thank you! Interview Inquiry Interview/Speaker Inquiry Name * First Name Last Name Email * Name of organization * Website * http:// Number of subscribers/attendees * What topic would you like Dr. Song to cover? * Other comments Thank you! Consultation Inquiry Consultation Inquiry Name * First Name Last Name Email * Phone (###) ### #### Name of organization * Website * http:// Organization's mission * Title of project and project description * How would you like Dr. Song to help? * Thank you! Workshop & Training Inquiry Workshop & Training Inquiry Name * First Name Last Name Name of organization * Email * Phone (###) ### #### Website * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Organization's mission * Workshop/training location * Anticipated number of attendees * Date of workshop/training * MM DD YYYY Title/theme of workshop * Describe what you want Dr. Song to teach * List any other instructors who may be presenting * Thank you! Speaker Inquiry Speaker Inquiry Name * First Name Last Name Email * Subject * Message * Thank you!
