Services Inquiry Form
Thank you for your interest in working with Collaborative ChangeMakers (Catalyst Counseling and Consulting, PLLC).    We currently have VERY LIMITED OPENINGS. Please read below to see if counselor availability works for you before completing the form.

***At this time, we are conducting all therapy sessions ONLINE via HIPAA secure videoconferencing.***
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Email *
Name
Phone number
What days and times are you available for counseling sessions?
Please indicate here if you want to work with a specific counselor?  (Click here to learn more about our counselors-- https://www.changemakerscounseling.com/meet-us/)
Please indicate any additional counselors you would be open to working with if the counselor indicated above has a full caseload, or is unavailable during the times you are available.
If you plan to use insurance, please indicate what insurance company you have.
Note: If you check other, our practice is probably out-of-network, and this may affect your fees.
Clear selection
In a few sentences, please state what you are coming to counseling to get help with.
Anything else you want us to know?
How did you hear about Collaborative ChangeMakers?
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Thank you for your time! We will get back to you promptly.
JOIN our MAILING LIST to be notified of upcoming events/workshops and tips/resources for mental health and wellbeing at https://www.changemakerscounseling.com/sign-up-form

Also, FOLLOW US on Facebook and Instagram for mental health information and events @collaborativechangemakers or @drmishelle
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