Aaron Thompson Consult Request Form
Please answer the questions below, and I will be in contact with you within 24 hours to set up a free consultation call to see how I can assist you in achieving your goals.
What state are you currently located in?
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California
Other
Are you looking for therapy for yourself or a friend or family member
Myself
My minor child
My adult child
My family
Other
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What type of therapy are you looking for?
*
Individual
EMDR Therapy
Other
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What is your gender?
Please Select
Male
Female
What is your age range?
Please Select
18-29
30's
40's
50's
60's
65+
What are you struggling with?
ADHD
Anxiety
Autism
Depression
Stress
Trauma
OCD
Other
Where are you looking to attend sessions?
In Person: Vacaville, CA
In Person: Roseville, CA
Online
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Parent or Guardian's Name
First Name
Last Name
Parent or Guardian's Phone Number
Please enter a valid phone number.
Email
example@example.com
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Client's Full Name
*
First Name
Last Name
Client's Contact Number
*
Please enter a valid phone number.
Client's Email Address
*
example@example.com
Availability
*
Monday
Tuesday
Wednesday
Thursday
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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