Let’s Figure Out Sliding Scale Rates.

Name

First Name

Last Name

Are you currently employed?

Describe your employment situation:

Unemployed

Receiving Unemployment Benefits

Social Security/Disability

Self-Employed (consistent income)

Self-Employed (inconsistent income)

Part-Time

Full-Time

Do you have any financial hardships that I should know of?

How often would you like individual sessions?

What duration of time would you desire to work with me?