Consultation Services Request Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

***********

IF YOU ARE A RETURNING CONSULTEE, PLEASE GO DIRECTLY TO MY SCHEDULING PAGE, HERE.

***********

This form is used to express interest in consultation services.

At the end of this form, you will be able to view my calendar and request a meeting time. However, you are only able to proceed with self-scheduling if you are paying in full at the time of booking. If you have financial need to request a reduced rate, please submit this form and the reduced rate form and I will follow up with you with a rate offer and will discuss scheduling with you then.

Full refund will be provided if after reviewing this request, I find that I am not the best fit to help you.

Email *

If Helsel Counseling's base rates are not financially possible for you, you can inquire about eligibility for reduced rate services, here. Once Helsel Counseling reviews your form, you will be contacted via Client Portal to fill out 2 follow-up documents then be sent an invoice based on your responses. Please do not purchase the services on the website if you are inquiring about reduced rates.

Note that services are not booked until payment is received.

I have read, understand, and agree to the above messages.
*

Yes

Required

Please state your first and last name, your pronouns, and your credentials.

(i.e. Hunter Helsel, MS, LPC she/her)

Provide your residential address, here.

What setting do you work in?

What topic(s) are you interested in consulting on? Please check all that apply. *

Trauma-informed care/Trauma therapy

Brainspotting/Somatic Interventions

Polyvagal Theory/Importance of engaging and acknowledging the nervous system in therapy

Safe and Sound Protocol/RRP

Solo Practice Management (Policies and procedures, organization, workflow, schedule, case management)

Starting a Solo Practice

Website building/design

SimplePractice

Intake Process and/or Treatment Planning

Progress Notes/Documentation

Case Consultation

Measurement-Based Care/Feedback-Informed Therapy

Diagnosing/Assessments

Marketing/Bio Language/Finding and describing your niche

Other:

Required

Please provide a description of what you're hoping to gain from our meeting, based on the topic(s) you'd like to discuss. This can include general information, questions, etc.

The more detail the better as it helps me prepare and also to know right off the bat if I am the best fit to help you as the service is non-refundable.

For Case Consultations, only:

Would you like to incorporate Brainspotting into our meeting(s), if appropriate?

This can help with increasing internal resources such as confidence and resilience related to your consultation topic or can help you come to an answer that is within you, instead of relying solely on the input of others. If so, please also fill out this form.

Yes, please!

Maybe. Let's see if it feels appropriate for this meeting or future ones.

No, thank you.

Clear selection

Booking link to self-schedule, here.

*If if you wish to schedule a 75 min. Consultation Service, you will need to contact me directly for scheduling.

**If you wish to purchase a Consultation Service Bundle (three 55 Min. Consultation Services for a 20% discount), you will find more information on the booking page.

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of helselcounseling.org.

Does this form look suspicious? Report

Forms