Name *

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Last Name

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Interested in using insurance for sessions? *

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Submission Consent

By submitting this form, you acknowledge and consent to the collection and processing of your personal information by Kristen Tandy/Holland Counseling for the purpose of responding to your inquiry. Your information will be handled confidentially and in accordance with our privacy policy. Please note that submitting this form does not establish a therapist-client relationship. If you are experiencing a mental health crisis or emergency, please seek immediate assistance by contacting emergency services or going to the nearest emergency room.

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