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Apply for Services

Apply for Services 2018-09-21T18:33:43+00:00

All of us need help sometimes. Get your individualized support starting today!

Meet your therapist…

This is a confidential form. All services will comply with HIPAA confidentiality standards.

Are you suicidal?
YesNo

Which paid service are you requesting?
CounselingPsychotherapyDream TherapyDreamWorkLife CoachHuman Design

Would you prefer online counseling, face-to-face counseling (in person), or both?
OnlineIn-PersonBothI don't know

Or contact Chris directly at (479) 308-1901