Discovery Call Request
Please complete the questions on this form & a provider will contact you within 24 hours
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Email *
Your Name *
Your Phone Number *
Your Preferred Method of Contact *
I understand that Mind by Design Counseling is a telehealth only counseling service *
I understand that Mind by Design Counseling is a private pay practice, does not accept insurance and provides courtesy OON billing & Superbills. *
Please select which provider or service you are inquiring about.  *
How did you hear about us? *
Feel free to enter any additional information that you'd like us to know about you including the reason your are seeking therapy services. 
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