Nooma Consulting Form
Name
*
First Name
Last Name
I am a/an
*
Please Select
Adoptive parent with a same race adoptee
Prospective Adoptive/Foster Parent
White Adoptive parent with a child of color
Foster parent with same race foster children
Foster parent with with a child of color
Adoptee seeking a consultation for ME
What country are you from?
*
Where is your adoptee from?
*
E-mail
*
What is your best day/time for a consultation?
*
Phone Number
*
-
Area Code
Phone Number
Please describe your current situation.
*
What plans are/have been in place to remedy the situation?
*
Please write 3 main questions based on your concerns/thoughts
*
Please upload any files/pieces of information that could help with this consultation
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First Time Client?
$15.00
$
15.00
1.5 HRS
$105.00
$
105.00
1/2 HR
$35.00
$
35.00
Quantity
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2
3
Item subtotal:
$0.00
$
0.00
Donate A Free Consultation To An Adoptee
$35.00
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
Consult Sunday (Donation welcome!)
Free
$
Free
Enter coupon
Apply
Total
$0.00
$
0.00
Each paid meeting will be conducted using an internet platform and will be recorded for the purpose of record keeping. A write up will be sent to each client with a summary of the conversation and suggested application. Three weeks later, a free follow-up can be requested. Please be aware that service costs are subject to change without warning.
***I'm not a therapist and each consultation should be viewed as suggestions***
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