2. Email Address

3. Cell Phone

(Best number to contact you)

4. Have you done counseling in the past?

5. Can you tell me what you have already tried? What has worked and what hasn’t worked?

6. How did you hear about The Therapist Next Door®️?

7. Tell me what your main struggle, or concern is.

8. How is this concern influencing or causing (additional) stress in your life?

9. On a scale 1 to 10, how ready are you to commit to therapy?

10. What days and times are you available?

11. Do you prefer In-Person or Telehealth appointments?

We are only providing Telehealth appointments at this time. Indicate preference below.

Therapy Inquiry Form

@thetherapistnextdoor