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Client Inquiry Form
Complete this form to receive additional information or to schedule a session with us. Please leave your inquiry and our Client Care Coordinator will get back to you soon.
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* Indicates required question
Name of client (teen)
*
Your answer
email (parent/guardian)
*
Your answer
phone number (parent/guardian)
*
Your answer
age of client
*
Your answer
Is there a particular type of therapy you are most interested in trying? (select all that apply or choose "I'm not sure")
*
DBT therapy for self-harm and emotional regulation
individual therapy to reduce symptoms of anxiety/depression
family therapy to address conflict/struggles within relationships
yoga/movement therapy
I'm not sure. I would love to hear more about what you offer.
Other:
Required
Do you have a preference for a particular therapist on our team?
*
Alexandra Papa
Ashley Jara
Kate Ketchum
Lauren Waag
Rachel Cohen
Robert Browning
I don't have a preference. I would like to discuss the options with you.
Required
How did you hear about us?
google search
social media
referral from school counselor or other professional
referral from current client
Other:
Please select your preference for the next step:
*
I am ready to schedule. Please send me options for sessions as soon as possible.
I still have several questions and would like to be contacted by email.
I still have several questions and would like to be contacted by phone.
Other:
Required
I would like to receive email updates from Colorado Teen Therapy about upcoming groups, parenting workshops and new services.
yes
no
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