Request Form


I’ve included several ways to contact me. Please give me a call, send an email, or simply fill out the form on this page.

Your Name (required)

Email Address (required)

Phone (optional)

Message (required)

I’m looking forward to speaking with you.

Jennifer Hill MS, LPCC #2992

Office Address

317 N El Camino Real #306
Encinitas, CA 92024
Phone: (760) 458-1600

We are committed to your privacy.
Do not include confidential or private information regarding your health condition in this form or any other form found on this website.

This form is for general questions or messages to the practitioner.