LI Counseling LLC

W e ’ r e  h a p p y   y o u ’ r e  h e r e.

Now let’s get to know you and what your goals are in therapy.

Please fill out the section below and we’ll reach back out to you as soon as possible.

"Therapy is not about fixing what’s broken; it’s about understanding, healing, and discovering the strength within."

Name

First Name

Last Name

Phone

(###)

###

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Insurance

LI Counseling works with out of network billing or private pay. Do you have insurance? If so, what plan. (If you don't- that's okay. We also accept private pay.)

Goals for Therapy:

What would you like to work on in therapy? Have you been in therapy in the past? Are you currently taking any medication?

How did you hear about us?