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Telehealth in Wisconsin & Washington

First Name*

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Last Name*

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Email or Phone (whichever you prefer for communication) *

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Which state do you live in:(required)

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When would you prefer sessions (select all that could apply):

Monday day

Monday evening

Tuesday day

Tuesday evening

Wednesday day

Wednesday evening

Thursday day

Thursday evening

Friday day

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Interested in:

Initial 15 minutes consultation ($0)

Regular rate intake/session ($195)

Pay What You Can Intake/Session ($1+)

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