Interest Form. Hello!
Ky'an Kelly, Licensed Mental Health Counselor
Name
First Name
Last Name
Email
example@example.com
Phone Number
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Crisis
If you are currently experiencing a mental health emergency please call 911, go to your local emergency room or community crisis center, or contact a mobile crisis team if you have access to one. For prevention support you can call 988 for the Suicide Prevention Lifeline or use their chat through suicidepreventionlifeline.org. Even though this is not the right time for you to work with me, I'm rooting for you, holding hope, and will be happy to welcome you when it's the right time.
Domestic Violence
If you are experiencing domestic abuse, your safety is important. National Domestic Violence Hotline has many supportive options and resources on thehotline.org. In addition to safety and stabilization, therapy may be beneficial to you, but my services are probably not the right fit at this time. Please consider a complex trauma and abuse specialist.
You are exploring interest in (select all that apply):
Individual Counseling/Therapy
MBCT Group Therapy
Parent Consultations
Payment Options
I am aware of the rates and payment options
I need payment information
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