Inquiry Form
Thank you for your interest in the work we can do together! 
Inquiries are responded to in the order received. You can reasonably expect a response on an office day, within 7 office days of submission.  It may take longer if I am out of the office, in which case I will respond as soon as possible upon my return.  If you do not get a response within 7 days, please wait to receive a response rather than submitting extra inquiries.
(For reference: Office hours are Sunday / Monday / Wednesday / Thursday EST 1-8pm / MST 11am-6pm / PST 10am-5pm) 
When there is availability for new clients the email response will include instructions to schedule a free 15 minute consultation. 

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Email *
What is your name (use the name you'd like me to call you here): *
What are your pronouns: *
What is your phone number: *
Where is your permanent residence located? Where will you be while sessions are conducted? 
(Counseling is offered to Florida, Colorado, and Oregon residents only. Coaching, professional consultation, group presentations and training facilitation does not depend on state residence.)
 *
What service(s) are you inquiring about?  *
Required
How did you learn about Medicine Within LLC or Steph Ostrow's services? *
Required
What else do you want me to know regarding your inquiry?  *
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