Copy of Getting Started NEW LAYOUT

Inquiry form

A place to voice your needs

This form is:

For us to better understand your need and find the best services that can help you.
For you to share more details about yourself and what you are looking for in terms of support.

If you are

Looking for mental health or nutrition counseling services
Exploring opportunities to grow alongside others on similar paths
A business looking for guidance or employee wellness workshops
A clinician who wants supervision or consultation with our experienced clinical team

Inquiry Form

(Legal) First name

(Legal) Last name

Pronouns

(Preferred) First name

Email

(Preferred) Last name

Phone number

May we leave a message?

Yes

No

What is your preferred method of contact (phone, email)

Relationship to client (self, partner, child, other)

If you selected “other,” please share what you’re looking for.

Preferred provider (list all providers, please connect me to the provider best suited for my needs)

Are there specific identities or qualities you’re looking for in a provider?

Payment options

Insurance

Self-pay

f you selected “self-pay” above, please note that our full self-pay rate for licensed clinicians is $175 per session. Our rates for intern therapists are $75 per session. Which self-pay option are you interested in?

Licensed clincian rate ($175)

Intern rate ($75) - mental health therapy only

Thanks, we will be in touch soon!

Inquiry form A place to voice your needs

This form is:

If you are

Inquiry Form

Stay updated with our offerings

Inquiry form

A place to voice your needs