COMING SOON.OPENING MID-OCTOBER 2025 Name * First Name Last Name Pronouns --- he/him she/her they/them something else (please specify in message) Email * To make sure we do not attempt to contact someone else accidentally, please make sure to include your email correctly. This should be your email that you feel most comfortable receiving confidential contacts for services. We do use encoded emails using Virtru to help with confidentiality, so if you do not hear back from us, please be sure to check your spam or junk email, and add us to your contact list or mark us as "not spam". Phone * In order to set up a phone screen to make sure we can provide appropriate services and get you set up, we will need a reliable number to call you. We will only leave a message about calling us back "from UCSB", and after two unsuccessful attempts, will need to hear back at least once before continuing to call again. (###) ### #### Best Time to Reach What would be the best time to reach you for a brief 15 minute phone call? Our intake specialist will attempt to call you around this time, Monday through Thursday, between 3pm to 8pm, to discuss some quick questions. Services of Interest * What types of services are you interested in or seeking? Individual counseling, family counseling, relationship/couples counseling, group counseling, referral, information about Healing Space, other? Subject * Message * Please describe a little about yourself. Thank you!
