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CONTACT/WAITLIST FORM 

Please fill out the following form to be connected with  a Calm Waters Counseling therapist. 
We currently are only providing individual therapy for ages 16 years old and above. If you request a therapist that is not taking new clients at this time, you will be placed on a waitlist.
Please note in the preference field if you do not want to be contacted via email and/or phone.
We cannot guarantee a specific time in which we will be able to schedule your intake. 
Filling out this form does not make you an active client at Calm Waters Counseling.
Clients will be contacted in the order they are received but availability, insurance, and fit will also be taken into account. 

Preferred Pronouns
I give you permission to contact me via: (please check all that apply)
What type of services are you seekin? What issues do you want to address?

2025 E. Main St. Suite 216

Richmond, VA 23223

calmwaterscounselingva@gmail.com

Tel:  804-644-0774

Fax: 804-644-0776

Office Hours-

Tue - Thur 10 am - 5 pm

Appointments available outside of office hours

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