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Home
Counselors
Services
Resources
Schedule
Counseling for a sound mind | sound life.
share with us a bit.
What type of Counseling are you looking for?
_
Individual
Couple
Teen
Child
Family
Do you prefer in person or telehealth?
_
In Person
Teleheath
Either works for me.
Preferred counselor?
I prefer to see a male counselor.
I prefer to see a female counselor.
No preference; Either works for me.
What is your age?
_
13-18
19-25
26-35
36-45
46-55
56-65
66-75
76-85
86 <
What is your relationship status?
_
Single
In a relationship
Married
Divorced
Widowed
Other
Are you looking for a religious faith to be incorporated in your counseling?
_
Yes
No
Potentially
Do you consider yourself to be Spiritual?
_
Yes
No
Other
Have you been to counseling before?
_
Yes
No
What led to you considering counseling today?
check all that apply.
I've been feeling depressed.
I feel anxious or overwhelmed.
My mood is interfering with my job/school performance.
I struggle with building or maintaining relationships.
I can't find purpose or meaning in my life.
I am grieving.
I have experienced Trauma.
I need to talk through a specific challenge.
I want to gain self confidence.
I want to improve myself but I don't know where to start.
Recommended to me (friend, family, doctor).
Just looking.
Other
What is your weekday availability?
Check all that could work.
Mornings (9am - 12pm)
Afternoons (12pm - 5pm)
Evenings (5pm-6pm)
How did you find us?
Friend or family referral.
Doctors referral.
Online.
Psychology Today.
A Podcast.
Social media.
Church community.
Other.
Is there anything else you'd like us to know?
Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Thank you for sharing.
We will be in touch!
