Intrepid Counseling Secure Contact
What can we help you with?
Brianna White is licensed in Washington and Georgia in the U.S. and cannot work with clients located elsewhere in the U.S. or Canada. Locations outside the U.S. and Canada Brianna can consider on a case by case basis.  *
Required
First Name
Last Name
Email address
Are you willing to receive a response to this inquiry by email? Consider that conventional email is inherently insecure and therefore poses a risk to the privacy and security of your Protected Health Information.  If you consent, Intrepid Counseling may communicate with you with via email with regards to scheduling, billing and payment for healthcare services. You are not required to give consent this consent in order to receive treatment and you can revoke it at anytime in the future.  Learn more. *
Phone Number *
Is it ok to leave a voice message at this number? *
Your contact is related to
Clear selection
Date of Birth (of the person who counseling will be for) *
MM
/
DD
/
YYYY
What is your address, including country?
How can I help you?
How did you hear about Intrepid Counseling?
Good Faith Estimate: A U.S. law called the No Surprises Act requires therapists to tell the cost of their services to anyone who inquires. Brianna White's 2025 fees are as follows: $230 for initial assessment, $115/session, usually weekly. More detailed fee information is available on request.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Intrepid Counseling.

Does this form look suspicious? Report