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Make An Appointment Form

To arrange for an appointment via email, please fill out the following form and submit it to us. We will call or email you with the appointment arrangements.

Personal Coaching/Counseling/Therapy is a professional service we provide to those who wish to work with a professional therapist. There is a fee for this service. By arranging an appointment, you are agreeing to our Rates and Terms of Service. Click here for our Rates and Terms of Service.

Use the form below to submit your appointment request:

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(example: 1-555-555-5555)

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What day and time would you prefer for an appointment?

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Please check to make sure all required areas are completed and that the information you want to send is correct. Also, double-check your email address to make sure it is correct because this is where our correspondence will be sent to.

When you are ready, click on the Submit button to send.

NOTE: By submitting this form, you are agreeing to our Rates and Terms of Service.

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