mood treatment center
Therapy Consultation Request
What type of visit are you using this for?
Phone Consultation ($55*)
Email Consultation ($30)
*Initial charge for phone consultations are $55. If they are longer than 30 minutes there is an additional charge for $40 for each additional 30 minutes.
Date of birth
Best time to call
Name a few times when you'll be available.
This form will go directly to the therapist you select.
Anna Leisa Sauser
Tell us about the concerns or problems you'd like consultation on.
Steps you've taken
What steps have you taken to improve things or resolve the problem already?
If we come up with a better solution, how would things be different? What would your life look like in the ideal outcome?
Anything else you'd like me to know (optional)?