Contact

Please use the form below to enquire about our therapy services.

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First and Last Name

Cell Phone

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What are the main reasons that you are seeking counseling at this time?
(Please check all that apply. You may explain more in box below.)

Depression / Persistent Low Mood Anxiety / Panic Attacks Grief / Major Loss / Bereavement Support for (In)Fertility Issues; including medical treatment (IUI, IVF, sterm/egg donor, surrogacy, etc) ADHD Assessment and/or Coaching Trauma: either a single event (PTSD), or long-term on-going trauma (C-PTSD) Religious Trauma / Spiritual Emergence Other (please describe in box below)

Please briefly describe (3-5 sentences) what issues you are wanting to explore in counseling at this time.

Please click to indicate your understanding:

I understand that Partners For Change Counseling, LLC only works with adult clients. I affirm that I am at least 18 years old and have graduated high school.