Request a 20-Minute Phone Consult With Wellness Counseling Center

Name*

First Last

IMPORTANT (check below)*

I understand Wellness does not accept insurance and is considered an out-of-network provider

IMPORTANT (check below)*

I understand if I choose to submit an insurance claim, Wellness will provide a receipt that includes required information and billing codes.

Email*

Phone*

Our Client Support hours are 10:00am - 4:00pm. Please let us know the best time to call to schedule your consultation.*

Your Time Zone*

Age

Spouse/Partner Name

Spouse/Partner Age

How long have you been together?

Do you have children?

What are the ages of your children?

Briefly explain the issues and concerns in your relationship:

Which therapist would you like your consultation with?

I am most interested in:

Have you ever worked with a Couples Therapist before?

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

Would you like to receive our eNewsletter and occasional updates, tips and ideas about relationships via email?

Request a 20-Minute Phone Consult