We are excited to welcome your child/children to our healing community. Before we begin we need to make sure we understand your needs to better serve your child. Please answer the questions below and our team will reach out to get your child/children onboarded properly. The site will be live in July, we are currently gathering the video content from counselors that your children will watch/interact with.
Email *
Your name *
Child/Children's first name *
How old is your child/children? *
Who did they lose? *
How long has it been? *
Has your child/children tried counseling before? *
If so, was it in person or online? *
Did you find it to be successful? *
What is your biggest pain point that we can help solve right now? *
We plan on pricing the platform for the video content/activities at $7.99/m do you feel this is a reasonable price? *
We plan on pricing 30-minute one-on-one video counseling sessions at $60 (not required). Available only if you need more resources/help.
Clear selection
Would the website or the phone/tablet app be more fitting for your family? *
Never submit passwords through Google Forms.
This form was created inside of Guardian Lane.