New Client Counseling Form

Please fill out the form. Once the form is submitted, we will email you with specific times that are available within one business day.

Please take the free Core Values Index Assessment, it is a required assessment for all our clients, in order to serve you best.

Core Values Counseling will not share your info. We respect your privacy and take protecting it seriously.

First Name *

Last Name *

Email *

Best Phone Number *

What can we help you with? *

Counseling: Individuals, Couples and/or Families

Couples Retreats and Seminars

EMDR (Trauma Recovery)

Neurofeedback: (Treats Trauma, ADHD, Anxiety, Depression and other issues)

CVI (Core Values Index): How you and others are wired?

Unpacking the CVI (Core Values Index)

Affair Recovery

Stress and Anxiety

PTSD Treatment

I am seeking counseling for:

Couples Counseling

Myself/Individual

Adolescent (ages 10-19)

Other

When Is The Best Time For Us To Call You? *

Mornings: 7:30am-9:00am, Monday-Friday

Afternoons: 3pm-6pm, Monday, Wednesday or Thursday

What can we help you with the most? Give a brief description. *

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