Consultation Request
Please complete these questions so we can best assist you. I will be in touch via phone, text or email to help set up a free consultation call where I can answer any questions or concerns. - Kathryn
What type of therapy are you looking for?
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Individual Therapy
EMDR Therapy
Group Therapy
Other
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What is your gender?
Please Select
Male
Female
Other/Not Listed
What is your age range?
Please Select
18-29
30's
40's
50's
60's
65+
Scale of 1-5, how hard has this been for you?
Please Select
1 (not too hard)
2
3
4
5 (it's been really hard)
What are you struggling with?
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Anxiety
Depression
My Relationship
Trauma
Phobia
Other
Where are you looking to attend sessions?
In Person: Roseville, CA
Online
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Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Availability
*
Tuesday
Wednesday
Friday
Times
*
Mornings (8 AM - 12 PM)
Afternoons (12 PM - 4 PM)
Evenings (5 PM- 8 PM)
How did you hear about Freedom Counseling Group?
Internet Search/Google
Recommended by a friend or family member
Recommended by a doctor
Other
Is there anything else we forgot to ask?
Let us know if there is any other information that would be helpful for us to be aware of as we match you. Please note we will need full names and email addresses for each potential participant if you are looking to participate in family or couples counseling.
Please verify that you are human
*
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