Your Name *

First Name

Last Name

Phone

(###)

###

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Partner's Name *

First Name

Last Name

Partner's Phone *

(###)

###

####

What services are you interested in? *

Communication Issues

Affair and Betrayal Recovery

Parenting Support

Perinatal/ Postpartum Therapy

Deeper Connection

Something Else

How would you like to meet with Kayla? *

check all that apply

In Person

Virtual ( offered to anyone living in South Carolina)

What days can you meet? *

Click all that apply

Mondays

Tuesdays

Wednesdays

Thursdays

What time(s) can you meet? *

Check all that apply. Please note: therapy services are not offered outside of 9am-4pm Monday-Thursday

Mornings 9am-12pm

Afternoons 1pm-4pm

Form of Payment *

Full payment is expected 24 business hours before the start of sessions. Payments are processed electronically via a secure plateform.

Credit/ Debit Card

FSA/HSA Card

Checkbox *

By checking this box you are indicating you understand and agree to the non-refundable deposit upon agreeing to work together.

I agree and understand that a non-refundable 25% deposit is required if I decided to book an initial session