Triangle Community Center (TCC) is launching counseling services for the LGBTQ community starting in February 2019. Supervised by an LMFT (Licensed Marriage & Family Therapist), MFT students will provide comprehensive counseling to individuals, couples, and families. 

There are a limited number of spaces available for counseling.

Please note that TCC does not accept insurance but fees for counseling services will be on a generous sliding scale with fees starting as low as $5.00 depending on income.

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* 1. Contact Information

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* 2. Date of Birth

Date

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* 3. Pronouns

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* 4. Are you already in therapy?

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* 5. Are you interested in individual, couples, and/or family counseling? Please check the boxes that apply.

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* 6. Will this be your first time in therapy?

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* 7. Please provide a 1-2 sentence statement on your reason for seeking therapy.

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* 8. What is your availability on Mondays? Please check all times that apply.

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* 9. What is your availability on Tuesdays? Please check all times that apply.

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* 10. What is your availability on Wednesdays? Please check all times that apply.

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* 11. What is your availability on Thursdays? Please check all times that apply.

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* 12. What is your availability on Fridays? Please check all times that apply.

Thank you for completing this form. A TCC staff person will reach out to you during the month of January 2019 to follow-up.

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