Counseling Wellness Online Therapy

Email Therapy Intake Form

All Fields Required

Your name:

Email:

Street
Address:

City:

Zip Code:

State:

Phone:

Name & Phone Number Of Emergency
Contact:

Best Time
To Call You:

What Are Your Presenting Problem or Focus For Counseling?

What Are Your Previous Counseling Experiences?

Are You Currently Having Any Symptoms And How Severe Would You
Describe Them?

How Often Would You Like To Receive Email therapy? You May Choose
One Session at a Fee of $45.00, or Unlimited Email Therapy For The
Month at $195.00

Would You Prefer a Male or Female Therapist?

Thank You For Your Therapy Request. A Clinical Supervisor Will Contact
You Via Email or Phone To Schedule Your Email Therapy session(s).

Counseling Wellness Therapy
The Place To Get The Help You Need

This method of counseling provides you with an opportunity to express yourself in written form to your
counselor. This type of counseling is very powerful for individuals who are very good at written expression, and
who feel that face-to-face video counseling or phone counseling is not a good match for them. Many clients
who prefer this form of counseling sign up for a months worth of unlimited sessions. The therapist answers
your email with thoughtful questions and helpful powerful tools that you can use to manage your life situation.
Counseling Wellness Online offers a monthly unlimited email package, the fee is $200.00 for the month. We
also offer one email exchange at $25.00 per email exchange. We highly recommend the constant support of
unlimited monthly email therapy. To begin your email therapy, please fill out the intake form. Then pre-pay for
your email therapy. We look forward to helping you.