Secure Contact Form

For mental health professionals interested in receiving specialized services from Gillian Clissold, LPC

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Thank you for contacting Quarternote Counseling and your interest in receiving professional training and/or supervision services from our practice's owner and Clinical Director, Gillian Clissold, LPC.

Please bear in mind that, because Ms. Clissold is a Licensed Professional Counselor, she is unable to provide clinical supervision towards licensure to supervisees in Clinical Social Work.

Please be aware that Ms. Clissold's availability for trainings and/or supervision services varies. Submission of this form does not obligate you to receive trainings and/or supervision services from Ms. Clissold, nor does it guarantee that she will be available or able to provide these services to you. This form is to express your interest only.

Please complete and submit this form. Your submission will be encrypted and secure. Fields with a red asterisk (*) are required. You will receive a response within 5 business days.

E.g., LPC, Resident in Counseling, etc.

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