Contact Us

Online Intake Form

Name(Required)

First Last

Birthdate

Email(Required)

Phone

I am a:

Missouri resident

International resident

We hold licensure in the state of Missouri, and are therefore able to counsel Missouri residents and International residents.

I am interested in meeting with:

Eric Gregory

Jamie Gregory

I am interested in:

Online Counseling (Telehealth)

In Person Counseling

I would like to:

Schedule a free 10-15 minute intake call

Schedule an appointment

Please provide a summary of why you are interested in counseling at this time.**

**Please include relevant symptoms, feelings, problems, or goals you would like to address in counseling.