Free therapy consultation

Name *

First Name

Last Name

Phone *

(###)

###

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Contact Preference *

How would you prefer I get in contact with you to schedule a consultation?

Phone

Email

Text message

Are you seeking therapy for yourself or someone else?

Please note: I have limited availability for couple's / family therapy

Myself

Someone else

Myself and someone else, together

What are you looking for support with? *

You can choose multiple options if you're looking for help with more than one thing.

Burnout

Trauma therapy (EMDR/Brainspotting)

Anxiety

Depression

Stress

Polyamory & open relationship therapy

Something else (explain below)

Indiana & Florida Residents *

I affirm that I will be physically located in the state of Indiana and/or Florida during services and understand Lykke Counseling & Wellness can only provide therapy to those who are located within the state of Indiana or Florida at the time of service

Agree

Insurance & Fees *

I understand Lykke Counseling & Wellness accepts Caresource Marketplace - Indiana, and that rate for a self-pay (out of network) 50-minute session is up to $180.

Agree