NOTIFY ME

Complete form and we'll notify you when we have openings.

Please correct the errors described below.

FULL-ACCEPTING status changes quickly. As one person wraps up, we can offer you sessions.

Conscious Living Counseling is currently FULL.

However, we can't reach you if we don't have your contact information.

I encourage you to complete the notification form.

Please note, that we'll only contact you when we're accepting new patients.

Thank you!



Date of Birth

PAYMENT INFORMATION

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    NON-TRADITIONAL COMMUNICATION CONSENT:

    We use HIPAA-compliant technology to reduce wait times, improve the intake process, and ensure that you have access to your provider when needed. We need your consent in order to move forward. Your provider will explain each service in detail.

    Your information will be encrypted.

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