Name *

First Name

Last Name

Phone *

(###)

###

####

May we leave a detailed message at this number? *

Yes

No

May we text this number? *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Assessments Disclaimer *

There is no cost for the phone assessment. This assessment is to help determine the type of service that may be appropriate for your family and to connect you with local service providers who have current availability. This assessment is not a therapeutic service.

I accept

Family Reunification Services and Fees *

Family Reunification services are not typically covered by insurance or state medical services. The costs for Family Reunification counseling and Family therapy need to be discussed with the service provider you choose. Most providers charge $90 to $150 per hour for Reunification Counseling. There are some options for a lower sliding scale fee through the Counseling Services Training Institute program with master’s level interns providing counseling. Fees for that program range from $25 to $75 per hour.

I accept

Information Review and Referrals *

Once your assessment is completed, the information you provide will be reviewed by our assessment team and you will be provided with information regarding recommended services and availability.

I accept