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Waitlist Intake Form
Thank you for your inquiry regarding Akoma Counseling Concepts services. Currently, we are not accepting new clients. However, if you wish to be considered on the waiting list please fill out the intake form. We cannot provide timelines for wait list times at this moment.
* Required
Email address
*
Your email
Name:
*
Your answer
Email address
*
Your answer
Phone
*
Your answer
How soon are you looking to schedule your appointment?
MM
/
DD
/
YYYY
The issue(s) I am seeking to treat in therapy (in 4 sentences or less):
Your answer
Have you been to individual therapy before?
Yes
No
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