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Unstuck Group Appointment Request
After you fill out this appointment request, we will contact you to go over details and availability of one of our practitioners. Please allow 24hrs (Mon-Fri) for us to respond to your request. If you have any additional questions or concerns, please contact us at
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Your Name (First & Last) & Preferred Pronouns *
Are you making this appointment for yourself or someone else? *
If the appointment is for someone else, what is their name & preferred pronouns?
Is this appointment for a new or existing client? *
Is this appointment for therapy or for spiritual care? *
Phone number *
Where do you live? (city & state) *
E-mail *
Do you have a particular member of the Unstuck Group team you would like to see? (if not, just skip this question)
Brief description of why you are seeking an appointment with us. This helps us to ensure we can help match you with the person who can best meet your care needs. *
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