Contact

Get in touch.

Interested in working together? Fill out this form to schedule a free 15-minute consultation, and I’ll be in touch within two business days.

During our call, you’ll have a chance to ask any questions about my approach and services. We’ll also briefly discuss what’s bringing you to therapy, what you’re hoping to achieve, and whether we’d be a good fit to work together.

If you'd prefer to reach out directly, you’re welcome to contact me through one of the following methods:

Phone: 909.375.9162
Email: jasminew@adaptiveresolutionscounseling.com

Name

First Name

Last Name

Phone

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How do you prefer to be contacted to schedule our consultation?

Due to licensing restrictions, I'm only able to work with clients in CA or AZ. Please confirm your state of residence:

What is prompting you to seek therapy at this time?

Note: Please do not include Personal Health Information in this form.

How did you hear about me?

Please select the payment method you plan to use if we work together:

Please note that submitting this form or scheduling a consultation does not establish a therapeutic relationship with Adaptive Resolutions Counseling. This form is not monitored for urgent concerns or emergencies. If you need immediate care, please call 911 or visit your nearest emergency room to get the support you need.

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