Counseling Evaluation

 

Thank you for your interest in Hand to Hold counseling services. Please fill out the survey below for evaluation of eligibility into the program.

You will be contacted 2-3 business days after your responses have been received for next steps.


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Question - Required - Best time to reach you for a 10-minute screening/intake phone call? (Please select at minimum two options from below)
Please make at least 2 selections from the choices below.

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Question - Required - Are you available on Tuesdays or Thursdays?
Please make at least 1 selection from the choices below.

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   Please leave this field empty