Consult Request
Please fill out this form to join our waitlist. (Thank you in advance for your patience!)

*Quick Tip: To apply for one of our groups, fill out our separate Group Consult Request form on our webpage.
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Email *
Full Name *
Phone Number *
City & State
Birthday *
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Age *
Who are you seeking help for? *
What are the main challenges you are wanting help with? (Don't worry about spelling/grammar!) *
How did you hear about us?  *
Required
Do we have permission to text you regarding phone consult details? *
Are you interested in enrolling in group coaching? (Mark all that apply).  *
Required
What is your general availability to attend individual/groups?  (We understand schedules change) *
Required
Which days of the week? *
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Is there anything else you would like us to know about you?
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This form was created inside of LMK Counseling LLC.