Therapy Interest Form

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If you would like to learn more about Pact's Center for Race and Adoption Focused Therapy, please complete the form below. As of July 2026 we have a waitlist for our child/adolescent/family therapists; there are immediate openings for parents seeking therapy for themselves (could be helpful while waiting for your child to start :)

First Name *

Last Name *

What pronouns do you use? *

She/her

He/him

They/them

No preference

Required

Email *

Phone *

Street Address *

City *

State *

Zip Code *

Your Adoption Status (Select all that apply) *

Adult Adoptee

Former Foster Youth

First/Birth Parent (had a child that was placed for adoption or placed into foster care)

Adoptive Parent

Resource/Foster Parent

Kinship Parent

Pre-Adoptive Parent

Non-Adopted Sibling

Extended Family Member

Other Adult

Required

Your Race/Ethnicity (Select all that apply) *

Black/African American

Latinx/Hispanic

Asian/Pacific Islander

Native American/Indigenous

Arab/Middle Eastern

White

Required

Your Date of Birth *

YYYY

What kind of information are you seeking about Pact's therapy program? *

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