Intimate Connections Counseling

Who would be receiving care?

My partner and me

Someone else

Your info

First name

Last name

Phone

Name you go by

State

Select the state you live in

City

Reason for care

What kind of support are you looking for right now?

You do not need to share anything you are not comfortable sharing. This helps us determine fit and next steps.

Individual counseling Relationship or couples counseling Sex therapy Coaching or non-therapy support Not sure yet

What is the reason you are seeking care right now?

You are welcome to share as much or as little as you feel comfortable. A few words is enough.

Limited to 600 characters

Billing & Payment

How do you expect to pay for services?

We ask this so we can let you know whether we are likely to be a good fit. You are not making a commitment here.

Self-pay / out-of-pocket Insurance (DMBA, EMI Health, PEHP) Third-party pay (e.g., family member, clergy assistance, employer benefit) Not sure yet

Client Preferences

Kristin's availability and session format

Kristin meets with clients via secure teletherapy/video conferencing on Tuesdays, Wednesdays, and Fridays between 9:00am and 5:00pm (Mountain Time). Sessions are held using a HIPAA-compliant video platform accessible from a computer, tablet, or smartphone. You are welcome to share your general availability for sessions below. We will do our best to accommodate scheduling needs or offer appropriate referrals if Kristin’s schedule is full.

Is there anything else that you would like us to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice.