Name *

First Name

Last Name

Phone

(###)

###

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What type of therapy are you interested in? *

Individual Sessions

Intensives

Group

If you are interested in Group Therapy, please indicate which group(s) spark your interest to help us determine which process & support groups to run next:

Complex Grief (ambiguous loss such as a breakup, career change, life transition, etc.)

Teacher Burnout (Current and former educators)

Caring Professional (Healthcare workers, therapists, etc.)