Schedule A Free Consultation | Interwoven Couples Therapy

Names (both partners required)

Your name

Partner's name

Pronouns (both partners required)

Your pronouns

Partner's pronouns

Emails (both partners required)

Your email

Partner's email

Phones (both partners required)

Your phone

Partner's phone

How did you hear about me? (required)

If you were referred by someone, please list their name.

Availability (required — mark all that apply) I work Monday-Wednesday and Friday. Please specify what times you would prefer. Please note I have limited evening availability.

Morning (8:30am-12pm) Afternoon (12pm-3pm) Evening (4pm-8pm)

Monday Tuesday Wednesday Friday

In-Person Telehealth

Message (required)

In a few sentences, help me understand why you are seeking couples therapy at this time?

Therapy Agreements (required) We understand that therapy is $180/80 minute session and will happen on a weekly/biweekly basis to get the most momentum for therapeutic change. Sessions are not available Thursday, Saturday, or Sunday. We understand Jen is an out-of-network clinician and that she does not take insurance. A superbill can be provided but does not guarantee insurance reimbursement. We understand that Jen is licensed in North Carolina and can only work with clients who live/attend sessions within the state. We understand Jen is an associate licensed professional and is currently under supervision.

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