Averill Hovey, MA, LPC-S, ATR-BC, EMDR
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Contact me for an Initial Consult.
Thank you so much for taking the time to answer these questions. Your answers help guide our initial contact. I will get back with you soon to let you know my availability.
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Name
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First
Last
Name of client (if not you) and/ or partner if couples work is requested
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First
Last
Phone Number
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Email
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Describe your/ your child's/ couple's age
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12-18
19-25
26-35
36-50
Over 50
Prefer not to say
{Couples: fill all that apply)
Describe your/ your child's/ couple's Gender
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Male
Female
Non-binary
Trans Man
Trans Woman
Other
Describe your/your child's/ couple's sexuality
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Heterosexual
Bisexual
Lesbian
Gay
Other
What challenges are getting in the way of you (or your child) leading the life you (or they) want?
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What strengths have supported you/ them thus far?
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What changes do you/ they seek to improve your/ their current experience?
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How would you know I have helped you/ your child/ your couple?
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What kind of frequency in appointments were you hoping for?
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How did you hear about me?
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Are you planning on utilizing insurance? And if so, what insurance coverage do you have at this time?
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If I cannot support you at this time, would you be interested in being added to a waiting list?
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Yes
No
Maybe
I would love some referrals if you have them.
By checking "agree" below, I recognize that, by submitting this form, I am sharing sensitive information over email, which may not be a secure means of communication. I am also recognizing that the therapist may respond to my inquiry via email. By checking below, I provide my consent for her to do so.
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Home
About Me
The Work
Location & Contact
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Perspective Clients
Educational Consultation
Supervision
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