Request a Free 30-minute Consultation

First, we want to gain a better understanding of your reasons for seeking psychological services, describe our services, and answer any questions you may have about the process. The decision to proceed with psychological services is only made after the consultation appointment by both the client and the psychologist. Unfortunately, we cannot fulfill all consultation requests and wait times for the consultation appointment may vary.

First name

Last name

Phone

Which type of service(s) are you interesed in?

Individual therapy

Couple/Relationship therapy

Group therapy

Psychological Assessment

What is/are the primary issue(s) you wish to address in therapy?

Anxiety (including Panic Attacks, Excessive Worry, Social Anxiety)

Bipolar Disorder

Borderline Personality Disorder

Depression / Low Mood

Insomnia

Managing Medical/Health Condition

Obsessive-Compulsive Disorder

Pain

Perinatal Depression /Anxiety

Relationship Issues

Sexual Issues / Dysfunction

In a few words, tell us more about why are you seeking psychological services?

How did you hear about us?

I confirm that I am seeking services for myself. I understand that I may not seek services on behalf of another individual (e.g., family member, friend).

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info@emeraldlightpsychology.com

Tel: (902) 440-9226

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