THERAPY SIGN UP

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THERAPY SIGN UP

Please use this to sign up for therapy services at Hazelbrook, one of our Clinical staff will reach out as soon as possible. Thanks!

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* Indicates required question

First and Last Name *

Your answer

Contact Phone Number *

Your answer

Email Address *

Your answer

What kind of therapy are you interested in? *

Individual Counseling

Group Counseling

Both

Are you currently a client at Hazelbrook Sober Living? *

Yes

No

Which Hazelbrook House? *

Your answer

Do you prefer in-person or virtual?

In-person

Virtual

Either/both

Clear selection

Are you court ordered to attend treatment? *

Yes

No

Submit

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