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IS THERE A QUESTION YOU WOULD LIKE  DR. SAMARIA TO ANSWER ON HER PODCAST OR YOUTUBE CHANNEL? 
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NO PERSONAL QUESTIONS WILL BE ADDRESSED (PLEASE DON'T ASK DR. SAMARIA PERSONAL QUESTIONS ABOUT HER PERSONAL LIFE.) *
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THIS FORM IS NOT FOR THOSE WHO NEED THERAPY SERVICES OR TO ADDRESS YOUR SPECIFIC ISSUE. DO YOU HAVE A QUESTION THAT OTHERS COULD BENEFIT FROM HEARING? IF YOU ARE  IN NEED OF THERAPIST AND A NORTH CAROLINA RESIDENT YOU MAY ATTEMPT TO SCHEDULE AT WWW.KINGDOMCREATIVECOUNSELING.COM OR IF YOU ARE LOCATED IN ANOTHER STATE VISIT WWW.PSYCHOLOGYTODAY.COM TO SCHEDULE WITH A THERAPIST IN YOUR AREA. *
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THIS FORM FOR HER  PODCAST ONLY. IF YOU ARE WISHING TO SPEAK DIRECTLY TO DR. SAMARIA, REQUEST TO BE ON HER PODCAST OR REQUEST HER AS A SPEAKER AT YOUR EVENT VISIT HER WEBSITE AT WWW.DRSAMARIACOLBERT.COM CLICK THE LINK THAT SAYS CONTACT. YOUR INQUIRY WILL NOT BE RESPONDED TO ON THIS FORM.  *
DR. SAMARIA WILL NOT ADDRESS QUESTIONS WITH MALICIOUS INTENT, NO GOSSIP, RUMORS, SMEAR CAMPAIGNS ABOUT HERSELF OR OTHER PEOPLE. SOMEONE ELSE'S DOWNFALL WILL NOT BE ADDRESSED ON ANY OF HER SOCIAL MEDIA'S.  *
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THIS IS NOT A THERAPY REQUEST FORM. PLEASE DO NOT ASK QUESTIONS OR MAKE STATEMENTS THAT WOULD CAUSE US TO QUESTION YOUR SAFETY. SHOULD QUESTIONS OR STATEMENTS LIKE THAT BE MADE IT COULD RESULT IN US GETTING OUTSIDE AUTHORITIES INVOLVED FOR YOUR SAFETY. (SUCH AS 911, MENTAL HEALTH CRISIS, ETC) EXAMPLES LIKE....."I NEED HELP, I CAN'T MAKE IT, I STRUGGLE WITH SUICIDAL THOUGHTS, PLEASE CONTACT ME RIGHT NOW IT'S AN EMERGENCY......" IF YOU ARE EXPERIENCING A MENTAL HEALTH EMERGENCY PLEASE CALL 911 OR  988.  *
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DO YOU WISH TO HAVE YOUR NAME AND QUESTION MENTIONED OR WOULD YOU LIKE TO REMAIN ANONYMOUS AND STILL HAVE YOUR QUESTION ANSWERED. DR. SAMARIA WILL NOT REACH OUT TO YOU DIRECTLY THIS FORM IS ONLY FOR HER PODCAST. *
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WHAT IS YOUR FIRST NAME AND EMAIL (OPTIONAL)
WHAT IS YOUR QUESTION? *
THANK YOU FOR YOUR INQUIRY. PLEASE SUBSCRIBE TO DR. SAMARIA'S SOCIAL MEDIA TO SEE IF YOUR QUESTION IS ADDRESSED. *
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