Inquire | Counseling

Please Read our Terms & Conditions page before proceeding.

First name

Last name

Birthday

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Day

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Email

Only answer the following questions to the extent in which you are comfortable.

What is the primary reason you are pursuing counseling at this time?

What are a couple goals you would like to grow toward through counseling?

What have you read on this site that has led you to inquire for counseling with Allie Molina, LIMHP, LPC, PMH-C?

I am paneled with several insurances. Please state which insurance you plan to use, or, if you will be self-pay.

Will you need telehealth options?

In-person only

Telehealth only

Both options

When you click 'Submit' on this form, you are stating that you have read, and agree to, the Terms & Conditions

Counseling Inquiry