Step 1 of 4 25% Help us understand you a bit more.Name First Last Email PhoneZip Code ZIP Code How'd you hear about us?GoogleSocial MediaFriendChurchCampus MinistryYouth MinistryOther Your preferences:I'm seeking counseling for...MyselfMy childOther (please specify relation)Child's first name First Child's ageRelationship to patient I'd prefer a...No preferenceFemale counselorMale counselorPreferred scheduleDays(select all that apply) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Time(select all that apply) 7am-10am 10am-3pm 3pm-6pm 6pm-9pm Preferred counselor (optional) What’s the reason for seeking counseling? Choose your plan.Plan Premium - $480/month for up to 4 video sessions/month and unlimited messaging Standard - $280/month for up to 2 video sessions/month and unlimited messaging Review your details.Total per month $0.00 Credit CardCard Details Cardholder Name Trouble signing up?Email us at help@gait.net.
