If you have a specific therapist request or demographic preference (e.g., gender, age, cultural background, etc.) please list them here as well as any modalities desired (child centered play therapy, couples, family, story work, EMDR, etc.). Please also note that this information will be sent via electronic communication and confidentiality cannot be guaranteed, so please do not share private or sensitive information.

By submitting this form you affirm that you are a resident of Washington state and consent to the electronic transfer of this information to The Ampersand Collective who will share your information with the psychotherapist you are matched with.