Here & Now Counseling
Complimentary Consultation Request
Welcome!
Thank you for your interest in Here & Now Counseling. We know reaching out for therapy can feel like a big step, and we're glad you're here. Please complete the brief form below so we can learn a little bit about what you're looking for and connect you with the therapist who may be the best fit. If we believe our practice is a good fit, a member of our team will review your responses and reach out within 48-72 business hours from hello@hncounselinggroup.com to schedule a complimentary 10-15 minute phone consultation.
Please note
Here & Now Counseling is an outpatient therapy practice. If you are experiencing a mental health emergency or need immediate support, please call or text 988, call 911, or go to your nearest emergency department.
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
Please enter your DOB
Which therapist are you interested in working with?
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Gigi Shami, LMHC
Joy Harlynking, LMFT
I'm open to whichever therapist is the best fit.
Are you seeking:
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Individual Therapy
Couples Therapy
EMDR Therapy
Are you interested in:
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In-Person Sessions
Telehealth
Both/Either
Will you be using insurance?
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Yes
No
I'm not sure
If yes: Insurance Company
If yes: Member ID & Group Number
What prompted you to reach out for therapy at this time?
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What are you hoping to get out of therapy?
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Which areas would you like support with? (Select all that apply)
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Anxiety
Depression
Trauma
Relationship Concerns
Stress/Burnout
Life Transitions
Grief/Loss
Self-esteem
Identitiy/Self-Discovery
OCD/Intrusive Thoughts
ADHD
Couples
Have you been to therapy before?
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Yes
No
If yes, what was helpful-or unhelpful-about your previous therapy experience?
(Optional)
Which statement best describes your current situation?
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I'm generally functioning well in my day-to-day life but would like some support.
I'm experiencing ongoing emotional distress that is affecting parts of my daily life (such as work, school, relationships, or motivation), and I believe outpatient therapy could help.
I'm experiencing severe emotional distress that is making it very difficult to get through my day, care for myself, or meet my responsibilities.
Is there anything else you'd like us to know before we connect?
How did you hear about Here & Now Counseling?
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Google
Psychology Today
Friend/Family
Another therapist
Social Media
Existing Client
Other
Please read before submitting: I understand that submitting this form does not establish a therapeutic relationship or guarantee services. I understand that Here & Now Counseling provides outpatient psychotherapy and that if I am experiencing a mental health emergency, I should call or text 988, call 911, or go to my nearest emergency department rather than waiting for a response to this form.
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Yes, I understand
Submit
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