Apply and Schedule Your Consultation

1

How did you first hear about Evergreen Counseling and Wellness?* This field is required.

Google

Facebook

Referral

Psychology Today

Other

2

Which of the following best describes your current relationship status?* This field is required.Please tell us a little bit about yourself, so that we can better understand your situation.

Single

Dating / Long Term Relationship / Engaged

Married

3

The relationship challenges you face at age 18 aren't the same as those you'll face at 68. To help us understand what you would most benefit from, which of the following best describes your age?* This field is required.

20's

30's

40's

50's

60's

70's and older

4

Can you tell me about yourself, and what's making you look for guidance at this time?* This field is required.Please be as detailed and specific as possible

5

Thank you! Since we only have a limited number of spots available to work with new couples, what are you looking to achieve as we work together?* This field is required.Again, please be as detailed and specific as possible. What’s your vision or dream here? What would you define “success” as?

6

And as I mentioned, spots are limited, only because there's only so much space available in the schedule. Why should we consider accepting you for one of those spots?* This field is required.Tell us what makes your readiness for this work unique or apparent...

7

Working with us usually requires an investment of at least $2,000. Have you made the funds available to make this investment right now?* This field is required.

Yes

No

8

Not Finished Yet... Last (And Most Important) Step! Please Confirm Your Contact Information Below, And Then Select A Time For A Consultation Call On Our Calendar* This field is required.STEP 1: Submit your contact information below. STEP 2: On the next page, click through and PICK OUT A TIME that works with your schedule. STEP 3: We'll contact you within 24 hours to confirm your scheduled appointment time.

Please enter your name

Please enter your email

Please enter your phone