Let’s work together

Are you ready and interested in working together? Fill out some info and I will be in touch shortly! Can't wait to hear from you!

All sessions are held via telehealth at this time*

Name

First Name

Last Name

Email

Phone

(###)

###

####

Preferred Contact Method

Phone

Email

How did you hear about us?

Reason you are seeking counseling

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Pronouns

She/her

He/him

They/them

Primary Language

English

Spanish

Best days and times for appointments (no weekend availability at this time*)

How did you hear about Terapia with Carol?