Amber Tucker Learn More About Counseling Form

First Name *

Last Name *

Email *

Phone *

What would you say is going on and how long has it been going on for? *

What have you tried in order to resolve your situation? (Select All That Apply) *

Which best describes your experience with counseling:

New to counseling

Tried counseling before with some success

Tried counseling before, but wish I had a clear plan with steps to follow

What would you like to accomplish with my help? *

My significant other is open to couples counseling? *

Yes

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