Counselors Network
All information on this form will be kept strictly confidential to The Blue Dawn's trusted volunteers and will not be shared with anyone else without your explicit consent. We take your privacy very seriously.
Please tell us your name (or how you'd like us to call you)
Your answer
Phone number where we can call or message you
Your answer
Your email address
Your answer
Please tell us the location of your practice (Name of your city/town/village)
Your answer
Prefer to be contacted by
What is your preferred therapy method (CBT/Narrative/DMT etc)
Your answer
If you have a preferred age bracket for clients, please mention it below
Your answer
Can you let us know your session charges that you would be offering to us/if there is any sliding scale rate?
Your answer
If you would like to be associated with us in any other way, do let us know below
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