Schedule Free Consult | Revive & Transform Counseling PLLC

Revive & Transform Counseling PLLC

Use this form to schedule a free 15 minute consult to see if we are a good fit!

First Name

Last Name

Phone

Which of the following services are you seeking? Required

Individual Therapy (Adult)

Therapy for my Child (Child/Adolescent Individual)

Family Psychotherapy/Psychoeducation

Uncertain

Please provide any information you would like me to know before I contact you (such as time of day for contact, age, or main concerns). Do not include any identifying health information (such as diagnoses, treatments, medications, or allergies) on this form.

Please select all that apply: Required

I am comfortable paying the full standard rate.

I am interested in learning about superbills and how to provide documentation to my insurance for reimbursement.

I would like to learn more about sliding scale spots.

Thanks for submitting!