Consultation Request

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Complete this form to request consultation with Ana M. Salazar, LPC-S
Please allow 2-3 business days for a response. (Mon-Fri, except major holidays)

For my wellness, caring for my family, and ensuring I have enough energy and spirit to care for my clients, I have a schedule for checking various emails. But usually, I will get back to you within a few days.

I hope our schedules and goals align to allow us to collaborate together but I cannot guarantee that my training, expertise, or worldview will fit your needs.

If for whatever reason we cannot collaborate, I will do my best to work with you to find alternative options.

I respect your time and consideration.

Name *

Email *

Organization

My work setting is most like... *

an public agency or non-profit agency

private practice or group private practice

contracted or providing services via a third party (i.e. Better Help, Talkspace, etc.)

educator, professor, trainer, or related settings

Higher education helpers or university/college counseling

none of these fit me

Other:

My experience for peer professional consultation is most like...

Licensed professional counselor (or equivalent)

Licensed clinical social worker

Other mental health professional

Provisionally licensed mental health provider (i.e. LPC Associate)

Other mental health or wellness helper

Other:

Clear selection

What areas do you feel you most need consultation in? (Select all that apply) *

Professional development on a particular topic

Preventing burnout as a mental health provider or helper

Improving my personal wellness approach as a mental health provider or helper

Critiquing, evaluating, and analyzing my presentation materials and approach for educational/conference environments

Critiquing, analyzing my materials for other public speaking environments

Case consultation

I've been out of school and need an update OR there are elements of my education I need to fill in with research, resources, and information

Other:

Required

How soon are you hoping to collaborate? (Please note, if you have urgent or emergent consultation needs for client welfare, this is not an appropriate method for consultation as I cannot guarantee availability.) *

Within the next two weeks

Within the next month

No rush, just want to collaborate!

Other:

In short, how would you describe your areas where you need consultation, collaboration, or help?

Submit

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