CONTACT

Name *

First Name

Last Name

Phone *

(###)

###

####

Which service are you seeking? *

Counseling

Mindfulness-Based Stress Reduction 8-week Class

Mindful Self-Compassion 8-week Class

Group Training or Workshop

Health Insurance *

Please indicate your understanding that it is the client's responsibility to verify the details of their behavioral health coverage with their insurance carrier (i.e. deductible, co-payment/co-insurance, etc.)

I understand

Location *

Current regulatory rules allow counselors to practice within the state(s) that they are licensed. Do you reside in Michigan?

Yes

No