Thinking About Starting Therapy?

1

What is your name?* This field is required.

First Name

Last Name

2

How would you best describe what you are seeking help with:* This field is required.(select all that apply)

I'm feeling anxious OR Anxiety

I'm grieving OR Grief

I'm feeling depressed OR Depression

Self-Esteem & Self-Confidence

I’m going through a life transition OR Life Transitions

I’ve experienced trauma OR Unprocessed Trauma

I'm experiencing relationship issues OR Relationship Issues

Something else not listed here

3

What type of therapy are you seeking* This field is required.(select all that apply)

Individual Therapy

Couples Therapy

Family Therapy

Support Group

CBT Therapy

Somatic and Experiential Therapy

Trauma Therapy

I'm not entirely sure what I need

4

Is there anything else you would like to share?

5

How would you like to be reached?* This field is required.

Phone

Email

Both/Either

6

What's the best email to reach you at?* This field is required.

example@example.com

7

What's the best phone number to reach you at?* This field is required.

Please enter a valid phone number.