Email Counseling Submission Form


THERAPY begin therapy questionnaire 1 questionnaire 2 email counseling chat therapy make appointment contact me TOPICS depression panic attacks anger management addiction dual diagnosis grief & loss codependency childhood trauma on being a therapist RESOURCES Johari window my child within shattered serenity prayer control/responsibility empathy taming the mind mindfulness stress management self-care assertiveness healthy boundaries meditation mistaken beliefs basic human rights helpful quotations helpful books helpful movies helpful links	Home / My Credentials / Counseling Philosophy / Online Therapy / Services & Fees / Confidentiality / Begin Therapy / My Office / In Crisis Now? / Testimonial / Contact Me / Sitemap
	Email Counseling Submission Form You must be at least 18 years old to complete this form. You must not be suicidal or a threat to others- if so, go to In Crisis Now? If you have not completed the Questionnaire, then go to Begin Therapy for further instructions. If you have completed the Questionnaire, then fill out the Email Counseling Submission Form below. Email Counseling Submission Form Note: Before filling out this form, you must choose the method you prefer me to use to reply to this submission. If you are not sure whether to choose Safe-mail or Regular Email, then go to Two Options to review the choices. If you want to set up your free and secure Safe-mail account now, then go to Safe-mail. It takes less than five minutes to sign up, and it is free. (Note: When Safe-mail asks for your email address during registration, it means a new user name of your choice for Safe-mail, not your current personal email address.) First Name: Last Name: (optional) Email Address: Repeat Email Address: Tell me in specific terms what you want me to respond to in my reply. What exactly is it you would like help with? What is it you would like to know about or better understand? What is it you would you like to cope with more successfully? The text box will expand in size as needed. Which method do you want me to use to respond to your submission? Safe-mailRegular Email If you chose Safe-mail, what is your Safe-mail user name: @Safe-mail.net (If you don't know it, you can email it to me later.)
	*Be sure to bookmark this website for easy return.* Click on the photo below to request online therapy.. for a new beginning... Home / My Credentials / Counseling Philosophy / Online Therapy / Services & Fees / Confidentiality / Begin Therapy / My Office / In Crisis Now? / Testimonial / Contact Me / Sitemap Copyright 2005-2008 Serenity Online Therapy Text and photos by Carl Benedict except where noted

"Our very life depends on everything recurring 'til we answer from within." Robert Frost