Book Vashonna
First Name
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Last Name
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E-mail
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Phone Number
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-
Area Code
Phone Number
Presentation/Workshop of Interest
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Please Select
Speaking Engagement
Workshop
Training
Consulting
Clinical Supervision
Which do you prefer?
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In Person
Online
What is your status?
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Clinician
Entrepreneur
Both
How long have you been licensed to practice?
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License type?
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LSW
LAC
LPC
LCSW
Are you currently in private practice?
Yes
No
What are your days and hours of operation?
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you interested in opening a private practice?
Yes
No
What is your time frame?
0-3 months
3-6 months
6-12 months
2 or more years
Time frame for opening a private practice?
0-3 Months
3-6 Months
6-12 Months
2-Years or More
What is your budget?
What is your Budget?
$0-$2,500
$2,500-$5,000
$5,000-$10,000
Over $10,000
Business status?
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Starting a business
Currently in business
How long have you been in business?
*
Name of Event
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Event Website
Location
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Presentation Budget
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# of Attendees
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Target Audience
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What level of consulting services are you interested in?
Individual sessions ($175 per session)
Business Start Up (6 sessions $950)
Business Systems and Structure (one year program $3,600)
Business Marketing and Branding ($499 3 sessions).
Business consultation ($89 30-minute session)
Other
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