Counseling Interest Form

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I’m so glad you’ve found your way here. This form is a chance for you to share a bit about your story and what you’re looking for, so I can see if my services are the right fit for your needs. While completing this form doesn’t guarantee that we’ll work together, it is an important step before scheduling any intake or consultation. Because there is a high demand for services, I review each inquiry carefully to ensure my time—and yours—is used in the most meaningful way. Your honesty and openness here will help me determine how best I can support you, or if a trusted referral might be a better fit. Your privacy and safety remain my priority.

Please note: I do not accept insurance and do not provide out-of-network billing. All services are private pay. Pricing is firm, with no discounts or sliding scale. If you’re here, you’ve already taken a powerful step. But getting out requires your diligence—blaming others or relying on traditional therapy alone will keep you stuck or prolong the inevitable. If you’re truly ready to leave, invest in yourself. Let’s stop trying to make sense of what happened and instead uncover the light that will guide you into your next chapter.

First and Last name *

Email address *

Where are you located (city, state or country/province) *

Contact Consent *

I consent to receiving email from Caroline Fithen, MA (required to move forward)

I do not consent to receiving email from Caroline Fithen, MA

Required

I’m sorry you’re in a position where you need these services, but I’m proud of you for taking this step. How can I help? *

I'm interested in group supports

I'm interested in individual counseling intensives - solely focused on your mental wellbeing and booked in 2, 4 or 6 hour increments (6 hour can be split between 2 consecutive days)

I'm interested in individual coaching - focuses on strategy with therapeutic insight (inclusive of all facets of your situation, not just mental health)

I'm not sure, so could use a consultation. (Please note: consultations are $150 per hour)

Referral/recommendations for additional supports (i.e. parenting, divorce, somatic, etc)

Required

Please provide a brief description of what support you're looking for or case specific information.

Signature *

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