Let’s Begin Your Healing Journey Name * First Name Last Name Email * How did you hear about Bloom Within Counseling? * Google listing, Google ad, Facebook (what page), Client referral, etc Session Type * Individual Adult Session Individual Minor Session Couple/Family Session Parent Session Free Consultation Do you have Insurance * Yes No Best Session Time (Mon.-Thurs.; morning, afternoon, evening) I do my best to accommodate my clients' schedules, but ultimately it will come down to availability. Second Option (Mon.-Thurs.; morning, afternoon, evening) What brings you to counseling? * What issues are you having? Give as much information as you feel comfortable sharing.
