Waiting List Form
Please complete this form to be added to our waiting list. We will contact you when an opening matching your preferences becomes available. Thank you for your patience.
Moscow Counseling LLC | 828 S. Washington St., Suite C | Moscow, ID 83843
Today's Date *
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First Name *
Last Name *
Phone Number *
Voicemail Allowed *
Texting Allowed *
Email Address *
Preferred Appointment Times *
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Contact and Confidentiality Disclosure
By providing your contact information in this form, you are granting Moscow Counseling LLC to contact you in the near future. We can not guarantee confidentiality in making an effort to contact you if others have access to your phone or email.
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