Intake

INTAKE FORM

Thank you for your consideration regarding a following important matter. It helps us run our business in an efficient manner.

When a client fails to cancel a scheduled appointment with less than 48h notice, we cannot use this time for another client. Your card will be charged the full amount of a counseling session ($150/1 hour; $225/1.5hours; $300/2hour) in case of a no-show or if you cancel / reschedule within 48 hours of your appointment. A valid credit card is required to secure your appointment:

* Indicates required field

Name (as printed on the card) *

First

Last

Email *

Phone Number *

Address (billing) *

Line 1

Line 2

City

State

Zip Code

Country

Card Number *

Expiration Date *

Security code *

Submit

​INTAKE FORM

NO NEED TO WAIT ANYMORE. Make ANGER Work for You

INTAKE FORM