Contact Form
Please use this form to reach out to us. Do not use this form for emergencies. We will respond within 24-hours.
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Name *
Email *
Pronouns *
Phone number
State Located *
How can we help? *
In 2-3 sentences, what are you looking for help with? *
What are you looking for in a therapist? Do you have a particular therapist you are interested in seeing? *
What can you afford to invest in therapy? *
Are you hoping to use insurance to access therapy? *
What days/times are you available for therapy? *
How did you hear about us/who referred you? *
Would you like to be added to our email list for updates on availability and new offers? *
Please share any identities or social locations you would like to. We prioritize the needs of QTBIPOC. *
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