Request a Free Consultation
Send your contact details and availability so Orchard can call you within a week of your request.
Fifteen minutes, no charge, no obligation. Send this request and we will call you from Orchard's phone, (770) 686-0894, within a week of your request. Please do not include private health details on this form. This form is not monitored for emergencies. If you need help right now, call or text 988, call 911 if someone is in immediate danger, or go to your local emergency room. You can also find crisis and supportive resources on our website: OrchardHumanServices.org/c
Your full name
*
First Name
Last Name
If the counseling is for a child or teen, a parent or legal guardian completes this form.
Best phone number for our call
*
By providing your number, you give us permission to call you for the consultation.
Format: (000) 000-0000.
Email address
*
example@example.com
Where will you be physically located during sessions?
*
Georgia
Virginia
Who is the counseling for?
*
Myself
My child or teen
Couple
Family
When are the best times to call you in the coming week?
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Weekday mornings
Weekday afternoons
Weekday evenings
Saturday mornings
Which session fee fits your situation?
*
$40 reduced fee works for me
I would like to request one of the limited partial scholarships to help pay for care
May we send you text messages?
*
Yes, you may text me
No, please do not text me
May we email you?
*
Yes, you may email me
No, please do not email me
May we leave a voicemail if you do not answer?
*
Yes, you may leave a voicemail
No, please do not leave a voicemail
Send my request
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