Request for Therapy/Counseling
We are honored that you are interested in seeking services with us at Indigenous Circle of Wellness. We invite you to complete this interest and request for therapy/counseling form. It is recommended that you visit our website at
to become familiar with our practice, our providers, the services we offer, including rates*, and our approach to wellness.
*We are a private pay practice (we currently do not accept insurance for payment), however we offer sliding scale (reduced) rates when available.
Please note that we are only able to provide therapy/counseling services in the state of California.
If you have any questions or concerns please email us at
or call us at 626-782-5570.
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This form was created inside of Indigenous Circle of Wellness, Inc..