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Therapy Service Waitlist
Please complete this form to be placed on the waitlist for therapy services with Brittani Strozier, LMFT.
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Phone Number *
Today's Date *
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DD
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Name *
Age *
How did you hear about Grounded Hues Therapy & Wellness? *
Which therapy service would you like to receive? *
Please briefly describe your reason for seeking therapy? *
Do you currently reside in Georgia or the District of Columbia? *
*Please note: at this time, services are only available to residents in Georgia or DC.
What is the best way to contact you?
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