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About
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Contact us

Please fill out a contact form and we will respond within 48 business hours.

Your Name:

If Applicable: Your Partner Name

Phone Number

Email Address:

If Applicable: Partner Email Address

Have you tried counseling before? If so, what worked and what did not work?

Service(s) Interested in:

Individual Counseling Couples Counseling Business Partnership Counseling Discounted Counseling Press Other

Therapist you’d like to work with:

Jessica Cook, MFT ($200-$250 / Daytime In Person & Virtual) Veronica Walton, MFT ($175-$220 / Daytime In Person & Virtual) Kristina Zakir, MFT-C ($140-$180 / Daytime Virtual & In Person) Chloe Miller, MFT-C ($140-$180 / Daytime Virtual & In Person) Lauren Aldridge, MFT-C ($150-$180 / Daytime & Evening In Person & Virtual) Mckenna Paulsen, LPC ($175-$220 / Daytime & Evening Virtual) Melanie Grundvig, MFT-C ($140-$170 / Daytime & Evening Virtual & In Person) Kristen Oliver, MFT-C ($140-$180 Afternoon & Evening in Person & Virtual) Christina Abood, MSW, LCSW ($175 / Daytime Virtual) No Preference I / We Don’t Know A waitlisted therapist (Please state in the comments below who’s waitlist you’d like to be added to)

Desired Availability (We will do our best to accommodate)

Weekday Mornings (7am-10am) Weekday Early Afternoons (11am-2pm) Weekday Later Afternoons (2pm-5pm) Weekday Evenings (5pm-8pm)

Desired Availability (We will do our best to accommodate)

In Person Virtual No preference

PLEASE READ:

I understand that Modern Love Counseling DOES NOT ACCEPT INSURANCE and cannot accept payment from medicaid holders.

Form Disclaimer

I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.

I understand that clinicians at Modern Love Counseling offer virtual sessions with limited in person appointments. Due to our licensure limitations, COLORADO RESIDENTS only.

What is most important to you: (check all that apply)

Change / Growth Feeling Heard Being Held Accountable Tools Healing Clarity Connection & Safety Learning Forgiveness

What do you feel you need the most from your therapist? (Check all that apply)

To be understood To be direct & guide To have knowledge to educate To be relatable To feel safe To be objective To have a more modern approach and understanding of my experience To hold me (if applicable and my partner) accountable Human connection

Specifically, I/we would like support with: (check all that apply)

Learning more about myself/ourselves Learning how to trust Healing from past trauma Healing specifically from sexual trauma Working through gender identity and/or sexuality / LGBTQ+ Working through religious trauma, existential identity and/or shared beliefs Reconnecting Preventative counseling and enhancement Spirituality & depth psychology Becoming new parents / restructuring life as a parent High conflict resolution Dating Self love Emotional Regulation / Anxiety Reduction Family Of Origin Grief Infidelity / Betrayal

Please share a couple sentences about why you reached out so we can match you to a therapist: