Contact us.hello@newmoonrisingwellness.comPhone (text or call): 615.212.8614Fax: 615.285.8099 Name * First Name Last Name Email * Phone * (###) ### #### Preferred Method of Contact * Phone Call Email Text Who are you seeking therapy for? * Me My partner and myself Someone in my care (i.e. child, family member, etc.) Family member(s) and myself together I am not seeking therapy Would you like to be contacted by our team to pair you with a therapist who could be a great fit (free of charge)? * Yes No Preferred Therapist * No Preference Peggy Allbritten Cara Allison Sarah Barns Cara Clarkson Betsy Coughlin Suzanne Davis Sara Beth Geoghegan Elly Haddad Blake Howard Kelsy Kerr Laurence Lopez Jessi Page Evan Richardson Christa Riches Brittney Sceals Rachel Sellers Bradford Talley Matthew Teague Megan Thomas Jolene Underwood Katelyn Walter DeAnn Whalen Elizabeth Woods Primary Issue Seeking Counseling For * Anxiety + Depression Eating Disorders + Disordered Eating Racial/BIPOC Identity Exploration Body Image Relationship Counseling Exploration of Gender or Sexual Identity Faith Transitions or Religious Trauma Family Counseling Grief + Loss Auto-Immune + Chronic Pain Neurodivergent-Affirming Care Obsessions and Compulsions (OCD) Perinatal + Postpartum Life Transitions Trauma Recovery Other/Unspecified Type of Service Requested * Brainspotting EMDR Heart Math LPC-MHSP Supervision Play Therapy for Children Somatic Experiencing Somatic Experiencing Personal Session (SE Students Only) Talk Therapy Unspecified/Other Hypnotherapy Internal Family Systems (IFS) Which type of clinician are you open to seeing? * *Sliding Scale rates available across all counselor levels Senior Counselor (session fees range from $125-160) Associate Counselor (session fees range from $110-150) Graduate Level Intern (session fees range from $20-80) Preferred Location * Please check all that apply. In Person - Franklin In Person - Brentwood Virtual Teletherapy (TN Only) Preferred Appointment Days * Please check all that apply. Monday Tuesday Wednesday Thursday Friday Saturday Sunday Preferred Appointment Times * Please check all that apply. Morning Afternoon Evening How did you hear about us? * Thank you, someone will be in touch soon!
