First Name
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Last Name
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Email
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Phone
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In order for your therapist to provide the best level of care, please provide a brief summary describing your goals in therapy, the type of support or services you are seeking, or any additional information you would like to share:
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We can only provide services in the state of California. Check here to confirm you reside in California:
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Yes, I/we reside in California.
We are a self-pay only office. However, we can provide a SuperBill for you to submit to your insurance provider for potential reimbursement.
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I understand.
Messaging Consent
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By providing your phone number, you agree to receive text messages from Courageous Counseling Center. Message and data rates may apply. Message frequency varies. Reply STOP to opt out.
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