If you are a veteran and feel like you would benefit from regular phone or web-based counseling sessions with a licensed counselor, please sign up below. These counseling sessions are offered free of charge to veterans. We respect your confidentiality. Feel free to use a pseudonym if you'd prefer; just make sure that all of your contact information is accurate.
First Name *
Last Name *
Primary Phone Number *
Email Address *
Your Current Zipcode *
Are you comfortable or proficient at using Google Hangout/Meet? *
How did you hear about us? *
If the option you selected above contains an asterisk, please provide the full name of the person or organization you were referred by, as well as any relevant contact information you may have for them. We'd love to be able to recognize their contribution.
Please describe any considerations that should be taken into account when we match you with a counselor. The more specific you are, the better we'll be able to place you with someone who specializes in any area you'd like help with. *
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This form was created inside of Rosebud Advocacy, Inc.