New Client Waiting List
Thank you for your interest in Renewed Counseling & Play Therapy! Please fill out the form below and we will reach out to you shortly. 
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First and last name: *
Birthday: *
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Email address: *
Phone number: *
What issues are you hoping to address in counseling? *
Would you prefer to meet in person or virtually? *
When are you available to have counseling sessions?
The more options you choose, the more likely we will have availability to accommodate your schedule.
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Afternoon
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Saturday
Is there anything else you would like us to know?
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