Counseling Inquiry Form

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Thank you for your interest in working with us at Creative Spirit Collaborative. This contact form is for those seeking individual counseling with our therapists (below). If you're interested in other one-on-one services, please visit our Individual Services page. If you'd like to explore our community groups, classes, and workshops, please visit our Community Services page. If you'd like to contact us for other reasons (including collaborations and other opportunities) please contact us here.

Name *

Preferred Pronouns

Phone Number *

Email *

Please tell us about what you are seeking services for? *

What types of approaches are you interested in?

Somatic

Nature-Based

Expressive Arts

Meditation/Mindfulness

EMDR

Other:

Do you have a preference for online or in person therapy?

Online only

In person only

Either are fine

Clear selection

What types of therapy are you interested in?

Individual Therapy

Family/Couples Therapy

Group Therapy (Transformational Wellness Group)

Do you have preference for specific practitioners?

Rachelle (Private pay, OHP PacificSource, PacificSource Commercial, BCBS, Kaiser NW, Moda, Shasta (Conf. Tribes))

Jonathan (Private pay, OHP PacificSource, PacificSource Commercial, BCBS, Kaiser NW, Moda, Shasta (Conf. Tribes))

Solomon (Private pay, OHP PacificSource, PacificSource Commercial, BCBS, Shasta (Conf. Tribes))

Gillian (Private pay only)

Emily (Private, Pay, OHP PacificSource, PacificSource Commercial, Kaiser NW, Moda, Shasta (Conf. Tribes))

Olivia (Private Pay, OHP PacificSource, PacificSource Commercial, BCBS, Kaiser NW, Moda, Shasta (Conf. Tribes))

Maren (Private Pay, OHP PacificSource, Shasta (Conf. Tribes))

To better help us determine which services and/or therapist would be the best fit for you can you please tell us what days and times you may be regularly available for sessions?

Monday

Tuesday

Wednesday

Thursday

Friday

Other

Mornings 9-12

Afternoons 12-4

Evenings 4-7

Other

To better help us determine which services and/or therapist would be the best fit for you can you please tell us whether you plan to use insurance or private pay? If you have insurance, please indicate OHP/PacificSource Community Solutions, PacificSource Commercial, Kaiser NW, Cigna, BCBS, Moda, or other type of insurance (which would be out of network with us). *

What is the best way to contact you?

Phone

Text

Submit

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