1 on 1 therapy sign up
Please fill in the form below
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
County of Residence
*
I prefer to meet
In Person
Virtually
I am most accessible
Mornings
Afternoons
Evenings
Please provide a little background over your reason for seeking therapy?
First Session is Free. Afterwards counseling is offered at a discounted rate of $40 an hr for all members or members can choose other discounted package options
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60 Minute Therapy Session
$40.00
$
40.00
3 Session Therapy Package
$100.00
$
100.00
6 Week Therapy Package
$200.00
$
200.00
Clients meet once a week for six consecutive weeks.
Total
$0.00
$
0.00
Payment Methods
Credit Card
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
SUBMIT
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