Ready To Get Started?

first name

last name

email address

phone number

I am . . .

seeking mental health support making a referral interested in hiring you to speak at an event or interviewing you for a publication interested in consulting with you to make my workplace more parent-friendly marketing services or a product

How did you find me?

referred by provider

friend or colleague

internet search

social media

other

please describe

Are you ready to invest time and money to improve your mental health?

Yes, I'm financially prepared to invest in my mental health. No, I do not have the financial means to invest in professional support at this time.

Please utilize one or more of the following resources to find a provider who is a good fit for your needs and budget.

Postpartum Support International web site for their provider directory and support groups
Open Path Collective for a directory of affordable options
TherapyDen or Inclusive Provider Directory
Return to Zero Hope for support after a loss

Briefly describe your symptoms and what prompted you to seek support.

What would you like me to know about your patient or client?

patient's first name

patient's last name

patient's email address

patient's phone number

What is your preference?

please contact the patient

please be sure to provide contact info above

the patient will contact you

please refer the patient to my website or have them email me - hello@kaycehodos.com

How can I help?

Is there anything else I can do to help?

Please review the following information and check the boxes to indicate you understand.

I understand that fees start at $250 per session and my credit card will be charged the full fee at time of service.

I understand that Kayce Hodos is out-of-network and does not participate in my insurance provider network or any other managed care programs.

I understand that committing to sessions at least every other week in the beginning is required.

As stated above, this form isn't a marketing tool for you. Cold outreach is probably a poor use of your time. To learn how to effectively reach your ideal audience with email marketing, I recommend Liz Wilcox's courses and membership.

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