Name *

First Name

Last Name

Phone

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I am seeking counseling for:

Individual Counseling

Couples Counseling

Relationship Coaching

Nature Therapy

Other

My availability for 60 minute sessions is:

Weekday Mornings

Weekday Afternoons

Please check to indicate understanding of the following: *

Waitlist times vary and it may take several months to receive contact.

I am agreeing to be emailed when a spot opens up.

I understand that completion of this waitlist request form does not indicate a therapeutic agreement with Melissa Ryan, LPC.

If I do not hear from someone in 3 months’ time and I am still looking for a therapist I may complete this form again.

Click here to be added to my mailing list.