Sound Mind and Heart Counseling

+1-618-203-3444 info@soundmindandheart.com

Menu

Contact us

get in touch with our company


Send us a message

If you would like to be processed as a new client, please fill out the form below so that we can better serve you. If we have already spoken to you and have your information, please contact us at info@soundmindandheart.com

Hours: Mon-Thurs,

1pm 8pm Except holidays


Counseling Preference
IndividualCoupleFamily

Marital Status SingleMarriedPartneredDivorcedSeparatedWidowed

Previously married (you) YesNo

Previously married (partner) YesNo

Employment (you) EmployedUnemployed

Employment (partner) EmployedUnemployed

Education (you) HSCollegeOther

Education (partner) HSCollegeOther

Date of Birth (you)

Date of Birth (partner)

Are you involved in a church YesNo

Where?

How did you hear about us?