Consultation Interest Form

Consultation Interest Form
This consultation group is for you if:
- You are a fully licensed clinician
- You love collaborating with other clinicians
- You are willing to give as much as you receive
- You want/need peer consultation and want connection and desire to share your work and perspectives with others
- You are open to receiving constructive feedback and suggestions from group members you will grow to trust and respect
- You are willing to prioritize your monthly meetings and be present for your colleagues
The group meets once a month, every 1st Thursday with a maximum of 9 clinicians. We meet at 6pm. The group will be used to confidentially discuss cases, connect, and check in with each other. The group facilitators are Dr. Natasha Ramsey of Brave Spaces Counseling and Latisha Ellis of Empowered Transitions Counseling.
Name:*

First NameLast Name
Cell Number
E-mail*
example@example.com
I an willing to provide my professional license and sign an informed consent.*

YesNo
Practice Information
Name of Practice*
Website URL*
Who is your target population/pain point that you work with?*
Check if you think you might be interested in any of these other services:

Free BookclubProgress Note Party Session (Catch Up on Progress Notes)Podcast Guest
Should be Empty: