Request an Appointment

Emergency Assistance

If this is an emergency, call:

Crisis Line: 602-222-9444
911

Please note: At this time, all counseling and coaching sessions are being conducted exclusively by video (telemental health/telehealth). We will update this form to accommodate face to face therapy requests when they become available again.

Client Information

First name

Last name

Email address

Phone number

I'm already a client

Date & Time

Best days for an appointment (M-F)

Please indicate which days work best for you

Best times for an appointment)

We offer appointments as early as 8:00 AM and as late as 6:30 PM

About Your Appointment

Additional information

If there's anything else that you would like me to know prior to your appointment, please include it here.

I understand that I am submitting a request to engage in teletherapy with a clinician employed by Dynamic Counseling and Coaching Solutions, L.L.C. I understand that “teletherapy” includes consultation, treatment, transfer of medical data, emails, telephone conversations and education using interactive audio, video, or data communications. I understand that teletherapy also involves the communication of my medical/mental information, both orally and visually.

Statement of Understanding

I understand

Your information will be encrypted.

Dynamic Counseling and Coaching Solutions

At Dynamic Counseling and Coaching Solutions we believe whole people connecting with one another enhances the well-being of the family and the community. Similarly, people living and working together as whole communities will make the world better for all of us. To this end, Dynamic Counseling and Coaching solutions fosters the kind of individual growth that comes from intentional change by promoting health, healing and restoration.

(602) 777-1268
dccsaz.com
dccsaz
13201 N. 35th Ave. Ste B6, Phoenix, AZ, 85029