Thank you for taking an interest in the Trauma-Informed Services. Please take a moment and fill out this form. You have the option to pay for the service in full or make payments before our appointment. 

 *Partial scholarship for those that qualify.

 *Please Note: Before services can begin. A consultation is required if it's your first time working with us. A Consultation for 1 hour is required. 

***If working with a minor child, parent or caregiver agrees to learn and enter our parenting education program to give the parent the needed awareness, skills, and tools to help their children properly heal from trauma. ***
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Email *
Name *
Phone number *
What type of service are you looking for? (A partial scholarship for those that qualify and submit proof of hardship) *
Best Day to meet *
Morning 11-1pm
Afternoons 2-4
Evening 5-7
If the above times don't work, we can work around your schedule
Reason for seeking support and services. *
If seeking services for a minor are you willing to take our parenting class series to understand the behavior of the child that has experienced trauma. *
Are you in need of a partial scholarship ? (Proof of income must be provided. *
How will you be paying for service? (Zelle or Venmo) If seeking for a scholarship please write what type: Partial or Full Scholarship
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