Request a 15-Minute Discovery Call With Wellness Counseling Center

Your Name*

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I understand Wellness does not accept insurance and is considered an out-of-network provider. If I choose to submit an insurance claim, Wellness will provide a receipt that includes required information and billing codes.

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I understand Wellness offers both In-Person and Online Sessions.

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I understand fees range from $100 – $410 per session depending on the service and therapist I select.

Email*

Phone Number*

Your Age*

Spouse/Partner Name and Age*

How long have you been together?*

Do you have children?*

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The concerns you'd like to discuss:*

I am most interested in:

Couples Therapy/Pre-marital Counseling
1 Day or 2½ Day Couples Intensive
Individual Counseling

Have you ever been in therapy before?*

Yes
No

If yes, please share with whom plus a few details about your experience:

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