Submit a request

A valid email address is important so that we can get back to you quickly and efficiently. After you submit this form, we will review your request to determine if we have a Therapist available who would be able to meet your needs. If we do have a good fit, we will email you an intake packet, so please check your email for our response. Once you submit the completed intake packet back to us, we will give you a phone call to schedule your appointment as soon as possible. If we do not have a Therapist available, we will notify you of that via email. If you would prefer a phone call before moving forward, complete this form and indicate this in the last field of this request form. Connecting by phone typically takes a little longer due to the nature of everyone’s busy lives, which is why we do encourage the use of email as we get started. (By providing an email address, you are consenting to MySpectrum Counseling & Coaching emailing you regarding this inquiry).

Please provide any additional information that might help us resolve your issue in the Description box below. If there is nothing to add, just write "that's all."

Please supply any details about your billing issue that we need to know.

Please enter the details of your request. A member of our support staff will respond as soon as possible.

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