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PROGRAM Intake Form

Have a real conversation with a mental health professional to discuss your specific needs. We use online video technology for all our services and we match you to the PROGRAM that makes therapy accessible starting with this form. During your consultation, we WILL confirm a time for your FIRST SESSION.
 

​As a nonprofit community counseling agency, we prioritize meaningful support that is accessible to everyone, with an intentional focus on BIPOC and LGBTQ communities that deserve culturally flexible care. We also offer group meetings and BIPOC Healing Circles to grow community engagement and connection. 


Help us Help u... fill out this contact form completely: 

Check ALL TIMES We Can Reach YOU:
Are you directed to this form by any PROGRAM?
I CARE if my therapist comes from a specific background [leave blank to be matched faster]
I CARE if my therapist comes from a specific lived experience [leave blank to be matched faster]
I CARE if my therapist comes from a specific background [leave blank to be matched faster]
I CARE if my therapist comes from a specific background [leave blank to be matched faster]

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