Thank you for your interest in seeing a counselor. Counseling is free for youth 24 & Younger. Please fill out this form and someone will reach out to you to setup an initial intake appointment.

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* 1. First & Last Name:

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* 2. Age:

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* 3. Gender Pronoun:

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* 4. Phone:

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* 5. Email:

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* 6. Best days/times you are available for sessions:

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* 7. Have you been to therapy before?

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* 8. What you hope to get from therapy?

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