Schedule a Consultation Name * First Name Last Name Phone (###) ### #### Email * I'm interested in help with... * Individual Counseling Couples Counseling Family Counseling Group Counseling Equine-Assisted Psychotherapy Sliding Scale Pricing College Student Pricing Mental Health Professional Pricing Were you referred by anyone? * If yes, please indicate who referred you below Yes No Additional Message/Information (Optional) Please use this space to give any additional information and/or referral source information, thank you! *if you are inquiring about Group Therapy, please use this space to specify which group you are interested in Thank you for submitting your contact information to schedule a consultation. Please allow for 48-business hours for a reply. Minaret Therapeutic Services appreciates your time, thank you and take care!