Secure Contact Form

I look forward to connecting!

Name (First & Last)

Date of Birth

Email address

Phone number

Mailing Address, Including town & zip code

Location Note: Please be aware that I can only work with people physically located in the state of MA at the time of our session or consultation.

Text Consent

Please check below if you provide consent to receive a brief text in response to this message to coordinate a time to talk.

Confidentiality Note: If you choose to text to make contact, please be aware that text exchanges are not a protected or secure means of communication. Please keep the text brief and free of personal or identifying information. We can text to coordinate a call, but an intake can not be scheduled without verbal contact.

May I respond to this message by sending you a brief text to schedule?

If you are uncomfortable with text to schedule please let me know your preferred method below.

How Can I Help You?

What type of service are you interested in? Please review what I offer at www.LizCummingcounseling.com

Ongoing Psychotherapy

Short-term Psychotherapy

Connections Consultation

Befriending Unique Systems

Safe & Sound Protocol (SSP)

Please tell me a little more about your interest in what I offer. If you would like to consult, please clearly identify the consultation title of interest.

Image

Your information will be encrypted.