Life Coaching and Professional Therapy Inquiry Form

1
Name* This field is required.
First Name
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2
Name You Go By* This field is required.
3
Email* This field is required.
example@example.com
4
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Please enter a valid phone number.
5
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6
Please share in your own words what you are hoping to achieve by working with Dr. Thompson.
7
Are you prepared to invest in premium, psychotherapy and private-pay coaching to achieve your goal? Fees per session range from $112- $350. Your private consult is $230 (virtual, 60 minute session)* This field is required.
yes
no
8
What is the urgency of getting support?* This field is required.
I’m ready to get started right away
I’m gathering information, not ready to commit yet
I need a same/next day appointment
I need to start within the next 2-3 weeks
I’m not sure
9
Thank you for trusting Dr. Monique Thompson, a published author, life coach, and therapist with over 24 years of experience specializing in relationship recovery and mental health. You are in expert hands.* This field is required.How Can I Help? Keep in mind same/next day appointments are available
Infidelity Recovery Coaching for Couples
Relationship Coaching for Couples
Life Coaching for Adults
Professional Therapy for Depression, Anxiety, Bipolar Disorder, Adult Survivors of Sexual Trauma, or PTSD
Not Sure Yet, Open to Recommendations
10
If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

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