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What brings you to counseling? (general issues, symptoms, recommendation from another provider, etc) *

Is there anything specific you feel like you need from therapy? (type of provider, type of treatment, accommodations) *

What is your preferred availability (days, times that work best for you)? **It it not guaranteed that you will be offered an appointment with your preferred time slot, but we will do our best to accommodate you** *

Preferred Modality of Sessions (Check all that apply) *

In Person - Clinton In Person - New London Telehealth

Are there any specific providers you would like to see? (Check all that apply) *

Kate Fillion, LPC (Clinton, Telehealth) Molly Haynes, LCSW (Clinton, Telehealth) Jenna Cohen, LCSW (New London, Telehealth) Shannee Ladson-Varnell, LMFT (New London, Telehealth) Yasmin Fabian, LMSW (Clinton, New London, Telehealth) Silvia Werbowsky, LMSW (New London, Telehealth)

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