Savvy Intuition, LLC Consultation form

This short form helps us understand what brings you in and which service best fits your needs — whether therapy, coaching, or a relationship intensive.

🕒 Takes about 5 minutes
🔒 Your responses are private and confidential.

Frequently Asked Questions

Name*

First NameLast Name

Phone Number*

Used to reach you if follow-up is needed. Your number is not shared.

Email*

You'll receive next steps by email.

Date of Birth*

A secure client portal cannot be created without this information. Your information is not shared with anyone.

What is your profession?

Optional.

How did you hear about Savvy Intuition, LLC and/or who were you referred by?*

Are you currently in therapy?*

YesNoOther

What type of support are you seeking?*

Mental Health Therapy (Ohio clients only – insurance accepted)Couples Counseling / Relationship Therapy (private-pay)3-Hour Mini Intensive for Couple/Family (private-pay)Family Counseling / Parent-Child Sessions (private-pay or insurance)Pre-Marital Counseling (Prepare-Enrich Certified)Coaching or Relationship Consulting (private-pay, non-clinical, nationwide)Emotional Support Animal Services (evaluation does not guarantee a letter)Couple Crisis Intensive (private-pay; for relationships on the edge)Other

If Couples Counseling or Intensive, provide your partner's name (Couples are required to complete consultation forms individually not together.)

First NameLast Name

Urgency for Couples Crisis Intensive

Note: Intensive is private-pay and designed for rapid stabilization and a path forward.

Requested timeframe (ASAP / 1–2 weeks / Flexible)

What is your main concern or goal?*

How ready do you feel to start this process?*

1 is Just exploring, 5 is Ready to Start

Please select the type of sessions you would prefer:*

VirtualIn-Personboth

When are you generally available for sessions or consultations? (please provide timeframes that work for you)*

Identify your payment method (s)*

Are you interested in learning more about adjusted fee rates?

I have reviewed the Frequently Asked Questions (FAQ) on the website.*

YesNo

I understand that insurance does not cover couples therapy, intensives, or Emotional Support Animal Services.*

YesNo

I understand that some family therapy sessions may be private-pay, depending on focus.*

YesNo

Savvy Intuition, LLC

Contact Information

How You Found Us

Service Interest

ESA Evaluation/Letter

Your Current Situation

Availability & Logistics

Important Notes & Understanding

Final Questions