Veteran Counseling
If you are a veteran and feel like you would benefit from regular phone- and 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 *
Your answer
Last Name *
Your answer
Primary Phone Number *
Your answer
Email Address *
Your answer
Your Current Zipcode *
Your answer
Are you comfortable or proficient at using Google Hangouts? *
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.
Your answer
Please describe any considerations you think we should take into account in placing 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. *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Rosebud Advocacy, Inc. Report Abuse - Terms of Service - Additional Terms