Private Practice Workshop

Private Practice Group Consultation

February 27th, 2025. April 21st, 2025. June 2nd, 2025. All times 11:00am – 12:30pm EST
Customer Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Payment

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Check/Venmo
Private Practice Workshop: $50

Please make check payable to:

Nicole Wolasz
Phoenix Therapy and Wellness
337 Cleveland Drive, Suite 6
Cheektowaga, NY 14215

Please mail immediately - must be received within 14 days of registration.

Payment via Venmo: Pay to @nicole-wolasz

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Private Practice Group Consultation
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