Therapy Service Waitlist
Please complete this form to be placed on the waitlist for therapy services with Brittani Strozier, LMFT.
Email *
Phone Number *
Today's Date *
Name *
Age *
How did you hear about Grounded Hues Therapy & Wellness? *
Which therapy service would you like to receive? *
Please briefly describe your reason for seeking therapy? *
Do you currently reside in Georgia or the District of Columbia? *
*Please note: at this time, services are only available to residents in Georgia or DC.
What is the best way to contact you?
Clear selection
Never submit passwords through Google Forms.
This form was created inside of Grounded Hues LLC. Report Abuse