Mental Health Counseling Session

Mental Health Counseling Session
Legal Name*

First Legal NameLast Legal Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Valid Email Address*
YesNo
If you are 17 years old and younger, a guardian needs to complete release of consent form. I can give these forms to you or have your guardian accompany you to the first appointment.
Roosevelt Campus
Vernal Campus
ZoomIn Person
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