Services Inquiry Form
Thank you for you interest in working with Collaborative ChangeMakers (Catalyst Counseling and Consulting, PLLC). [We currently have VERY LIMITED OPENINGS. Please read below to see if counselor availability works for you before completing form.] Because we are usually in sessions with clients throughout the day this form is the most efficient way for us to set up services. Please answer a few questions below so we can determine how to best meet your needs.
Email address *
Your answer
Phone number
Your answer
Which location(s) are you willing to go to?
What days and times are you available for counseling sessions?
Your answer
Please indicate here if you want to work with a specific counselor? (Click here to learn more about our counselors--
Please indicate any additional counselors you would be open to working with if the counselor indicated above has a full caseload, or is unavailable during the times you are available.
If you plan to use insurance, please state what insurance company you have.
Your answer
In a few sentences, please state what you are coming to counseling to get help with.
Your answer
Anything else you want us to know?
Your answer
How did you hear about Collaborative ChangeMakers?
Thank you for your time! We will get back to you promptly.
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