Creative Counseling Services, LLC

Name *

Email Address *

Phone Number

Days/Times Available for Therapy (my hours are Mondays & Thursdays 1 pm - 5 pm and Tuesdays, Wednesdays, & Fridays 9 am - 5 pm; last appointment begins at 4 pm) *

Weekly or Bi-weekly Therapy (for children under age 12, I require weekly therapy for at least the first three months) *

Message (please do not include any sensitive information) *