Consultation Request Form
I'm looking forward to learning what's bringing you to therapy and discussing how I may be able to help you. To be respectful of your time please provide the information requested below. I will respond within 24 business hours of receiving this request. Thank you! ~Tracy

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Email *
Full Nme *
I'd love to know how you heard about me or Shades of Resilience Counseling? *
D. O. B

Email *
Phone Number
Have you taken some time to review the Shades of Resilience Counseling website (i.e. Bio, Fees, FAQs)? *
Which service are you interested in? *
If you are in need of a reduced fee, please select the tier that would best fit your needs for weekly or bi-weekly sessions (limited availability).
Is this the first time you've considered therapy? *
In a few words, explain your reason(s) for seeking therapy. Why are you considering therapy now? *
In a few words, describe what you hope to achieve from therapy?  *
Would you consider group therapy in the future?
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If you know, what are you looking for in a therapist?
Do You have any initial questions or comments?
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