Appointment Request

If you are ready to begin the life-changing work of therapy or have questions about the therapy process, please complete the form below.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Area of Concern

Please provide a brief description of the issues you would like to discuss.

Availability

Please provide us with information about when you would be available for an appointment.

Preferred Therapist

Do you have a preference for the therapist who would be working with you?

Preferred Location

Please indicate if you have a preference for office location.

Insurance

How Did You Hear About Us?

Acknowledgement

While Yetman Counseling Services makes every effort to ensure the privacy of your information, there are some inherent security risks when using electronic communication such as email to transmit personal information. If you would prefer to use an alternative method to make your appointment or request information, Yetman Counseling Services can be contacted by phone at (980) 272-7968.

I understand.

Appointment Request

Office Location

YETMAN COUNSELING, PLLC