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Consultation Form
If you are seeking out counseling/consulting services, please complete the form below.
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Why are you seeking out counseling/consulting services?
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Are you with any mental health conditions? If so, please list them below. If not, please type N/A.
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Have you been in counseling/consultation before?
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Do you have medical insurance? If so, please list the insurance company below. If not, please type N/A.
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Please list your email address below.
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