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Contact Sladich Counseling
This is not for emergencies. Please call 911 if this is a mental health emergency.
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Name of person completing this form
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Your answer
Reason for seeking counseling
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Your answer
Type of counseling you're interested in
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Individual therapy
Group therapy
Both
Contact information (phone or email)
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Your answer
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This form was created inside of Richard Sladich, MS, LCMHC, ASDCS.
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