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Name

First Name

Last Name

Email

Phone

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Message

Please indicate present concerns or issues you would like to explore in therapy, treatment requests, or questions regarding treatment.

Which service(s) are you interested in?

Individual Therapy

Couples Counseling

Supervision

Integrative Healing

If you will be using insurance, who is your insurance provider? If you will be using a self-pay option, please indicate below.

Which therapy location do you prefer?

In-Office

Virtual/Telehealth

No Preference

Email
info@serenelifecw.com

Phone
+1 (919) 335-5601

Office Address
3061 Berks Way, Suite 201 Raleigh, NC 27614

Choose a path that feels right for you.