Name *

First Name

Last Name

Phone *

(###)

###

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Your Availability

Morning

Afternoon

Evening

Flexible

Urgency Level

Next few days. Urgent!

Next 2-3 weeks.

Flexible.

Current Fee for Individual Therapy is $150 - $375/45min

Sessions are every week or every other week. If I'm not available I can refer to an associate if desired.

I can afford current fee

I need a reduced rate

Not sure

Men's Group Therapy? $125 to $200 per session

I'm interested in learning more about...

Every other Week Tuesday 5-630pm

Every Other Week Thursday 330-5pm

Video Session?

I mostly see clients via video

Prefer Video

Flexible

Prefer in person

Intensive Program

Heal faster and recover quicker with the Facing the Shadows Intensive Program. Twice the amount of therapy, tools and assessments in less than half the time.

Yes

Not interested

Not sure

Consultation Type

Free 10min Phone Call

Initial 45min Session $375