Contact us.admin@courageouscounselingct.com41C New London Turnpike, Suite 4Glastonbury, CT 06033 Name * First Name Last Name Phone * (###) ### #### Email * How did you hear about us? * Are you looking for faith-integrated therapy? * Yes, please! No, thanks! Please share a bit about what brings you to therapy.* * (For example, are you looking for support with anxiety, life transitions, ADHD, parenting, or something else? Feel free to share as much or as little as you’re comfortable with.) *Your privacy is important to us. Please avoid sharing sensitive or private medical information here, as this form may not be fully secure. By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Squarespace harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means. Terms of Use * Yes, I want to submit this form Thank you! A member of our administrative team will be reaching out to you within 48 hours. We look forward to connecting with you!
