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Consultation Services Request Form
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This form is used to express interest in consultation services with Helsel Counseling. 

At the end of this form, you will be able to view my calendar and request a meeting time. 

Full refund will be provided if after reviewing this request, I find that I am not the best fit to help you. 
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Email *
Please state your first and last name, your pronouns, and your credentials. 

(i.e. Hunter Helsel, MS, LPC she/her)
 *
Are you a group practice owner or an executive position at an agency/group, a pre-licensed clinician or a student? *
What setting do you work in? *
What topic(s) are you interested in consulting on? Please check all that apply.

Note that if you are planning on only booking one consultation, please only select one topic if you plan to go in-depth. Can select 2 if there is not a great need on either topic. Can select multiple if you plan to book more than one consultation within the next month or two.
 *
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.
 *
Step 1: Complete Consultation Agreement, here.
  • You will automatically be sent a copy to your email. Please check your spam if you do not see it in your inbox.
Step 2: Complete payment, here.
  • Payment is set up as a modified "pay what you can" fee schedule within an upper ($150) and lower ($75) limit. Note that the $75 fee is for students and pre-licensed therapists, only. Licensed therapists are asked to pay no less than $100, but should consider paying as close to the full rate ($150) as possible. Payment plan options are available at check-out. 
  • The invoice price is set to the maximum amount which is $200/55 min for Group Practice owners or in an executive position at an agency or group (no lower price option for these individuals). All those who are not group practice owners should be paying between $75-150 ($75/100/125/$150). You must type the amount you want to pay in the promo code area. i.e. if you wish to pay $125, you will type "125" in the box. 

No adjustments are provided for failure to follow these directions so please proceed carefully.
3. Book your Consultation, here.
  • I reserve Mondays for consultations but if you absolutely cannot meet on a Monday, I do allow booking on other days of the week, but you will need to email me separately to inquire about my schedule. Note that I do not allow scheduling outside of Mondays for reduced rate consultations that are less than $125. Again, payment plans are available as needed.
  • If after reading this form I feel I will not be able to meet your needs, I will reach out to you and will refund you in full.
Please check off each step (1-3) that you have completed before submitting this document. *
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