Application for Coaching with Karen Yates
Hello and thank you for your interest! Please fill out this short form so that you and your partner can meet me over Zoom for your free 15-minute consultation to learn how I may be able to help you. All the information you give me here is completely confidential and will not be shared.

I do mostly in-person sessions in Chicago but also will work online over Zoom.
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Your name *
Your personal email address *
Your pronouns *
Your partner's name *
Your partner's personal email address *
Your partner's pronouns *
How did you hear about my work? If a person referred you, please let me know who. *
Are you currently in couples counseling or therapy with a licensed clinical therapist? *
If you are in couples therapy, please provide the name  of your therapist for my reference. If they have a website, please list. (I will only contact them with your consent.)
If you are in couples therapy, are you interested in the potential of your therapist and myself consulting together for your benefit?
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Why are you interested in working with me? Check all that apply. *
Please add any additional information about yourselves here if you wish.
While we will be discussing things more over Zoom, do you have any questions or concerns you'd like to put here?
Next Steps! Our Virtual Meeting
After you submit this form, within 48 hours, I will contact you so that you and your partner can schedule your free 15-minute consultation with me on Zoom. If you don't hear from me, *please check your spam folder.* I'm looking forward to meeting you and thank you so much!
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