Potential Clients (Leads from contact Interest Form)

First Name *

Last Name *

Email Address *

Phone Number *

Choose One *

I am 18 or older seeking services for myself.

I am seeking services for a child under 18.

I am seeking services for an adult family member.

I am a professional or business seeking to connect with Lynell.

What services are you seeking? *

Individual Counseling

Your Brains Not Broken Group Program

Workshop / Presentation

Tell me more about you/ your organization and your reason for seeking services. *

How did you hear about me? (Therapy For Black Girls, Therapy Den, Friend, Instagram) *

Would you like to be added to the first to know email list?