Free Consultation Schedule Your Complimentary 15-Minute Consultation "*" indicates required fields The information you provide will help us connect you with the most suitable Therapist for your Free 15-minute consultation. This survey is not a formal assessment, diagnosis, or treatment. Your Current LocationAre you located in Texas, California, or Washington?* Yes No We ask about your location to ensure we provide the most appropriate care. Due to licensing regulations, our therapists can only offer online therapy to clients in Texas, California, or Washington during appointments. However, this restriction does not apply to the free consultation you're requesting. Therapy PreferencesWhich of our therapy services are you most interested in? Individual Therapy Couple Therapy Family Therapy Group Therapy Our therapists specialize in various areas of relational well-being. Please choose up to 3 that resonate with your current needs: Anxiety Management Marital & Premarital Counseling Relationship Enhancement Depression Support Stress Reduction Other AvailabilityPlease select your general availability for your free consultation: Weekday mornings (Monday - Friday, 8am - 12pm) Weekday afternoons (Monday - Friday, 12pm - 4pm) Weekday evenings (Monday - Friday, 4pm - 8pm) Our team is available Monday through Friday and will do our best to accommodate your schedule, taking your time zone into account. Additional InformationIs there anything else you would like us to know before your consultation? Your Contact InformationFirst Name*Last Name*Email Address* Phone Number*How would you prefer we reach out to you for your free consultation?* Email Phone Call Text Message By submitting this form, I agree to be contacted by the Institute for Relational Well-being (IRWB) using the contact information I've provided. I understand that this consent is not required to receive services and can be revoked at any time. I also agree to IRWB's Privacy Policy, which explains how my information will be handled in accordance with HIPAA.
