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Thank you for your interest in the KU Positive Psychotherapy Clinic. Please complete this form so that we can contact you to schedule a brief phone consultation.
First and Last Name
Email Address
Phone Number
Preferred contact method
Email
Phone
Phone (do not leave a message)
Are you 18 or over?
Yes
No
Enter your Birth Date with Year
Do you live in Kansas?
Yes
No
In general, what is your availability for a session? Please select all that apply. We understand that this will vary from day to day, but it will help us pair you with a counselor for your initial session.
Morning 9 AM to 12 PM
Evening 5 PM to 8 PM
Afternoon 12 PM to 5 PM
Where did you hear about our clinic?
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