Name *

First Name

Last Name

Are you 18 or older? *

Yes

No

What service(s) are you interested in? *

Counseling (Available for residents of PA or NJ only – In-person or Virtual Therapy)

Coaching (Choose between the 6-month program or individual sessions)

The EmBODY Confidence Collective (Join our supportive community)

Referring a Patient for Therapy Services

Staff Training, Presentations, Supervision, or In-Person Events

Collaborations (Podcast episodes, interviews, panel discussions, etc.)

Other (Please describe below)

Click to agree *

By submitting this form, I acknowledge that I have reviewed the services available on this website and have familiarized myself with the Frequently Asked Questions (FAQ). I understand that the purpose of scheduling a consultation call is not to ask general questions but to meet with Jess, share more about what I am looking for, and determine if we are a good fit for working together. If I have any preliminary clarifying questions that may impact my ability to participate in services, I will email Jess directly at jfry@embodyconfidencecounseling.org before scheduling the consultation call.

I agree