Name *

First Name

Last Name

Phone *

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What are you interested in counseling for? *

Please check at least one. This is not an exhaustive list, so if what you're struggling with isn't on there, check other and we can talk about it!

ADHD

Perfectionism/Anxiety

Trauma

Coping Skills

Grief

Identity Development

Depression/Suicidal Ideation

School Issues

Family Relations

Oppositional Defiance

Other

When are you available to meet for sessions? *

Please select all available times

Thursday Morning

Thursday Afternoon

Friday Morning

Friday Afternoon