Relationship Support Request

This form emails Jess directly.

By using this form, you acknowledge that email, by definition, cannot be HIPAA compliant, and that emailing Jess in no way constitutes nor confirms a formal working relationship.

It may take as long as a week to receive a reply.

First name

Last name

Partner's name

Partner's email

As your relationship support, my client is the relationship, and so all partners will be included in all communication. A unique email that belongs to your partner is required for a response.

Please describe your situation (select all that apply):

We are seeking general skills support (communication, decision-making, etc).

One or both of us manage addiction (active or historical).

We need help with betrayal recovery.

One or both of us is working with an individual therapist.

Other

Where are you located?

Relationship consulting support is available for clients located anywhere in the world. Jess is licensed as a therapist in Utah and Colorado, and can only support clinical diagnosis and documentation for insurance reimbursement for clients physically located in Colorado or Utah.

What type of support are you exploring?

Relationship Consulting (available to anyone anywhere, does not involve a diagnosis, medical record nor insurance)

Clinical Relationship Support (available in CO and UT, requires collaboration with an individual therapist and a diagnosis for superbills for insurance reimbursement)

How did you learn about Jess' work?

What else would you like Jess to know before scheduling a for-fee 120 discovery session?