Name

First Name

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What services are you interested in?

Individual Therapy

Couple Therapy

Family Therapy

Other type of Consultation

Preferred day for service:

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DD

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Will you be using insurance?

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Anything else you would like us to know or questions that you have?

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Mobile SMS Privacy Policy: PLEASE NOTE: By entering your phone number voluntarily and clicking AGREE, you agree to receive informational SMS messages (appointment reminders, account notifications, etc.) from us. Message frequency varies. Message and data rates may apply. for help, reply HELP or email us at shannon@actiicounselingconsulting.com. You can opt out at any time by replying STOP. See privacy policy terms and conditions outlined below.

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Let’s work together

For prospective clients who have Highmark, Aetna or Cigna you may also click here for a direct appointment link.

Mobile SMS Privacy Policy:

PLEASE NOTE: By entering your phone number above, you agree to receive informational SMS messages (appointment reminders, account notifications, etc.) from us. Message frequency varies. Message and data rates may apply. for help, reply HELP or email us at shannon@actiicounselingconsulting.com. You can opt out at any time by replying STOP. See privacy policy terms and conditions outlined here.

Let’s work together

Act II Counseling

shannon@actiicounselingconsulting.com