CINXE.COM

<!DOCTYPE html> <html class="no-js" lang="en"> <head> <meta charset="utf-8" /> <meta http-equiv="X-UA-Compatible" content="IE=edge" /> <title>TEMPLATE Counseling</title> <meta name="description" content="Get Tickets for TEMPLATE Counseling."> <meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0" /> <meta property="og:title" content="Counseling" /> <meta property="og:image" content="https://library.webconnex.com/polygon/170.jpg" /> <meta property="og:url" content="https://webconnexdesign.ticketspice.com/counseling" /> <meta property="og:type" content="website" /> <link href='//fonts.googleapis.com/css?family=Open+Sans:300,300italic,400italic,600italic,400,600|Roboto:400,400italic,500,500italic' rel='stylesheet' type='text/css'> <link href="//netdna.bootstrapcdn.com/bootstrap/3.0.3/css/bootstrap.min.css" rel="stylesheet" /> <link href="//netdna.bootstrapcdn.com/font-awesome/4.7.0/css/font-awesome.min.css" rel="stylesheet"> <link rel="stylesheet" href="/css/app.css?1732324735268"> <link rel="shortcut icon" type="image/x-icon" href="data:image/png;base64,iVBORw0KGgo="> <link rel="icon" type="image/png" href="data:image/png;base64,iVBORw0KGgo="> <link rel="apple-touch-icon" href="/images/apple-touch-icon.png"/> <link rel="apple-touch-icon" sizes="57x57" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="60x60" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="72x72" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="76x76" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="114x114" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="120x120" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="144x144" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="152x152" href="/images/apple-touch-icon.png"> <link rel="apple-touch-icon" sizes="180x180" href="/images/apple-touch-icon.png"> <link rel="icon" type="image/png" sizes="192x192" href="data:image/png;base64,iVBORw0KGgo="> <link rel="icon" type="image/png" sizes="32x32" href="data:image/png;base64,iVBORw0KGgo="> <link rel="icon" type="image/png" sizes="96x96" href="data:image/png;base64,iVBORw0KGgo="> <link rel="icon" type="image/png" sizes="16x16" href="data:image/png;base64,iVBORw0KGgo="> <style id="form-builder-css" type="text/css"> @import url("//fonts.googleapis.com/css?family=Lato:400,700"); 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} .app-container input .ticket-number label.selected, .fr-box.fr-basic .fr-wrapper input .ticket-number label.selected, .app-container select .ticket-number label.selected, .fr-box.fr-basic .fr-wrapper select .ticket-number label.selected, .app-container textarea .ticket-number label.selected, .fr-box.fr-basic .fr-wrapper textarea .ticket-number label.selected, .app-container label .ticket-number label.selected, .fr-box.fr-basic .fr-wrapper label .ticket-number label.selected, .app-container label.control-label .ticket-number label.selected, .fr-box.fr-basic .fr-wrapper label.control-label .ticket-number label.selected, .app-container div .ticket-number label.selected, .fr-box.fr-basic .fr-wrapper div .ticket-number label.selected { border-color: #562713; } .app-container input, .fr-box.fr-basic .fr-wrapper input, .app-container select, .fr-box.fr-basic .fr-wrapper select, .app-container textarea, .fr-box.fr-basic .fr-wrapper textarea { color: #000; } .app-container .registrant-list, .fr-box.fr-basic .fr-wrapper .registrant-list, .app-container .team-settings .btn:active, .fr-box.fr-basic .fr-wrapper .team-settings .btn:active, .app-container .team-settings .btn:focus, .fr-box.fr-basic .fr-wrapper .team-settings .btn:focus, .app-container .team-settings .btn:hover, .fr-box.fr-basic .fr-wrapper .team-settings .btn:hover, .app-container .receipt, .fr-box.fr-basic .fr-wrapper .receipt, .app-container .receipt .actions .btn, .fr-box.fr-basic .fr-wrapper .receipt .actions .btn, .app-container upgrades-field ul.upgrades li, .fr-box.fr-basic .fr-wrapper upgrades-field ul.upgrades li { border-color: #000; 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}; </script> </head> <body class="app-container remodal-bg">   <section id="root"><div class="form-header-wrap"><div class="logo-align-center header-type-none"><div class="form-nav-header form-header-full"></div></div><div data-testid="header-form" class="form-header header-type-none logo-align-center form-header-full"></div></div><div class="campaign-form multi-reg labels-left rounded-inputs full-width-fields undefined"><div style="display:none"><form autoComplete="off" novalidate=""><div class="field-banner banner_x5a0bb0427c1c133db824 field-banner--fw"><div class="banner__background" style="background-color:rgba(255,255,255,1)"></div><div class="banner__holds-content custom"><div class="banner__content fr-view"><p style="text-align:center"><span style="color:rgb(86, 39, 19)">Click <a href="#" rel="noopener noreferrer" target="_blank">here</a> to learn more about our practice and the services we offer!</span></p></div></div></div><div style="min-height:400px" class="field-banner banner_x9dfcf31c9798c0229597"><div class="banner__background" style="background-color:transparent"></div><div class="banner__holds-content custom"><div class="banner__content fr-view"><p><br/></p><h1 style="text-align:center"><br/></h1><h1 style="text-align:center"><span style="color:rgb(86, 39, 19);font-size:72px">NEW HORIZONS</span></h1><h1 style="text-align:center"><span style="color:rgb(86, 39, 19);font-size:48px">TELEHEALTH</span></h1><p style="text-align:center"><span style="color:rgb(0, 0, 0);font-size:24px">Virtual Counseling Appointments</span></p><p><br/></p></div></div></div><div class="field-banner banner_xef6d8b125ca6f859b727"><div class="banner__background" style="background-color:#562713"></div><div class="banner__holds-content custom"><div class="banner__content fr-view"><h1 style="text-align:center"><span style="color:rgb(255, 255, 255)"><strong>MEET YOUR COUNSELOR</strong></span></h1></div></div></div><div class="field-picture header-field"><div class="holds-content-image"><div class="label-align form-width has-text image-left"><div class="images"><img src="https://s3.amazonaws.com/uploads.webconnex.com/46722/alex-starnes-pk_t0lrh7mm-unsplash.jpg" alt=""/></div><div class="copy fr-view"><p><em><span style="font-size:24px">Dr. Frances Allmen</span></em></p><p>Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Et malesuada fames ac turpis egestas maecenas pharetra convallis. Mi proin sed libero enim sed. Id aliquet lectus proin nibh. Lobortis feugiat vivamus at augue eget arcu dictum varius duis. Mattis pellentesque id nibh tortor id aliquet lectus. Laoreet id donec ultrices tincidunt arcu non sodales. Lacinia quis vel eros donec ac odio tempor orci. Vitae ultricies leo integer malesuada nunc vel risus commodo viverra. Purus viverra accumsan in nisl nisi. Ac auctor augue mauris augue neque gravida in fermentum et. Ridiculus mus mauris vitae ultricies leo integer malesuada nunc vel.聽</p></div></div></div></div><div id="top"></div><div class="ticket-block" id="ticketBlock"><table class="holds-tickets"><thead><tr><th id="xa9974eb2f8ba44c04f76_description" colSpan="1" class="description no-event"><input type="text" aria-hidden="true" tabindex="-1" style="width:1px;opacity:0;padding:0px;margin:0px;position:absolute;left:40px" value="" class=""/>Tickets<div class="field-area multi-field"><div class="datePicker"><input type="text" id="xa9974eb2f8ba44c04f76" placeholder="Choose Date" aria-label="Choose Date" value="" required="" class="hasDatepicker"/></div> </div></th><th id="xa9974eb2f8ba44c04f76_cost" class="cost"></th></tr><tr><td colSpan="4" class="empty-block"><h2>Please choose a date</h2></td></tr></thead></table></div><section id="registrants" class="registrant-info"><div class="field-lineBreak registrant-field field-registrant-0"><hr class="solid line-break" style="border-width:1px"/></div><div class="field-codeBox registrant-field field-registrant-1"><div class="holds-coupon-code"><label id="xd6b4c4a0f3dbc6eb6aaa">Coupon Code</label><div class="field-area multi-field"><input type="text" aria-labelledby="xd6b4c4a0f3dbc6eb6aaa" value="" class=""/><button type="button" class="btn btn-primary" disabled="" aria-label="Coupon Code Apply"><i class="fa fa-spinner fa-spin"></i>Apply</button></div></div></div><div class="field-subtotal registrant-field field-registrant-2"><div class="holds-subtotal"><div class="label-like">Total</div><div class="field-area">$0.00</div></div></div><div class="field-lineBreak registrant-field field-registrant-3"><hr class="solid line-break" style="border-width:1px"/></div><div class="field-summary registrant-field field-registrant-4"></div></section><section class="billing" id="billing-section"><div class="field-textHeading registrant-field"><div class="label-align form-width"><h2 class="text-center">Billing Information</h2></div></div><div class="field-copyRegInfo registrant-field"></div><div class="field-name registrant-field"><div class="name sub-field"><label for="xbf7b3b596f168357bcab_firstName">Name<span class="required-field" aria-hidden="true">*</span></label><div class="field-area multi-field"><input type="text" id="xbf7b3b596f168357bcab_firstName" placeholder="First" aria-label="First Name" value="" required="" class="first"/><input type="text" id="xbf7b3b596f168357bcab_lastName" placeholder="Last" aria-label="Last Name" value="" required="" class="last"/></div></div></div><div class="registrant-field"><div class="credit-card-billing sub-field"><label for="x120f5677650e4599ac3d_cardNumber">Credit Card<span class="required-field" aria-hidden="true">*</span></label><div class="field-area"><input type="text" inputMode="numeric" name="cardNumber" id="x120f5677650e4599ac3d_cardNumber" placeholder="Card Number" required="" class="cc-number _lr-hide" value=""/><ul class="credit-cards"><li class="visa">Visa</li><li class="mastercard">Mastercard</li><li class="amex">American Express</li><li class="discover">Discover</li></ul></div></div><div class="exp-date"><div class="field-area multi-field offset"><select name="expMonth" class="date-month" aria-label="Credit Card Expiration Month" required=""><option selected="" value="">Month</option><option value="1">01</option><option value="2">02</option><option value="3">03</option><option value="4">04</option><option value="5">05</option><option value="6">06</option><option value="7">07</option><option value="8">08</option><option value="9">09</option><option value="10">10</option><option value="11">11</option><option value="12">12</option></select><select name="expYear" class="date-year" aria-label="Credit Card Expiration Year" required=""><option selected="" value="">Year</option><option>2024</option><option>2025</option><option>2026</option><option>2027</option><option>2028</option><option>2029</option><option>2030</option><option>2031</option><option>2032</option><option>2033</option><option>2034</option><option>2035</option><option>2036</option><option>2037</option><option>2038</option><option>2039</option><option>2040</option><option>2041</option><option>2042</option><option>2043</option></select><input type="text" name="cvv" placeholder="CVV" aria-label="CVV" inputMode="numeric" maxLength="4" size="4" value="" class="cc-cvv _lr-hide"/></div></div></div><div class="field-address registrant-field"><div class="address holds-address"><div class="sub-field"><label for="x928997ca260e8b48167d_country">Address<span class="required-field" aria-hidden="true">*</span></label><div class="field-area"><select id="x928997ca260e8b48167d_country" class="country" aria-label="Country" required=""><option value="" disabled="">----------------------</option></select></div></div><div class="sub-field"><div class="field-area offset"><input type="text" id="x928997ca260e8b48167d_street1" placeholder="Street Address" aria-label="Street Address" value="" required="" class="street1 form-control long full-width"/></div></div><div class="sub-field"><div class="field-area multi-field offset"><input type="text" id="x928997ca260e8b48167d_city" placeholder="City" aria-label="City" value="" required="" class="city"/><select id="x928997ca260e8b48167d_region" class="state" aria-label="State" required=""><option selected="" value="">State</option><option value="AL">Alabama</option><option value="AK">Alaska</option><option value="AZ">Arizona</option><option value="AR">Arkansas</option><option value="CA">California</option><option value="CO">Colorado</option><option value="CT">Connecticut</option><option value="DE">Delaware</option><option value="DC">District of Columbia</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="HI">Hawaii</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="IA">Iowa</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="ME">Maine</option><option value="MD">Maryland</option><option value="MA">Massachusetts</option><option value="MI">Michigan</option><option value="MN">Minnesota</option><option value="MS">Mississippi</option><option value="MO">Missouri</option><option value="MT">Montana</option><option value="NE">Nebraska</option><option value="NV">Nevada</option><option value="NH">New Hampshire</option><option value="NJ">New Jersey</option><option value="NM">New Mexico</option><option value="NY">New York</option><option value="NC">North Carolina</option><option value="ND">North Dakota</option><option value="OH">Ohio</option><option value="OK">Oklahoma</option><option value="OR">Oregon</option><option value="PA">Pennsylvania</option><option value="PR">Puerto Rico</option><option value="RI">Rhode Island</option><option value="SC">South Carolina</option><option value="SD">South Dakota</option><option value="TN">Tennessee</option><option value="TX">Texas</option><option value="UT">Utah</option><option value="VT">Vermont</option><option value="VA">Virginia</option><option value="WA">Washington</option><option value="WV">West Virginia</option><option value="WI">Wisconsin</option><option value="WY">Wyoming</option><option value="AA">AA</option><option value="AE">AE</option><option value="AP">AP</option></select><input type="text" id="x928997ca260e8b48167d_postalCode" placeholder="ZIP Code" aria-label="ZIP Code" value="" required="" class="zip postalCode"/></div></div></div></div><div class="field-email registrant-field"><div class="email"><label for="xca4c19f3effd5741b848">Email<span class="required-field" aria-hidden="true">*</span></label><div class="field-area"><input type="email" id="xca4c19f3effd5741b848" placeholder="Email Address" value="" required="" class="long"/></div></div></div></section><div class="submit-row"><button type="submit" class="next btn btn-primary"><i class="fa fa-spinner fa-spin"></i> Submit</button></div></form><section class="holds-wc-logos"><div><a data-testid="powered-by-link" href="https://www.ticketspice.com/?utm_medium=Page+Footer&utm_content=TEMPLATE+Counseling&utm_referrer=https://webconnexdesign.ticketspice.com/counseling" target="_blank"><img data-testid="powered-by-logo" src="https://images.webconnex.com/bacon/ticketspice-black.svg" alt="TicketSpice Event Ticketing Software"/></a></div><div class="poweredby"><a href="https://www.ticketspice.com/?utm_medium=Page+Footer&utm_content=TEMPLATE+Counseling&utm_referrer=https://webconnexdesign.ticketspice.com/counseling" target="_blank" style="text-decoration:none"><span data-testid="powered-by-text">Event 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lifecycle\":{\"start\":\"2024-11-23T11:16:07.937Z\",\"end\":\"2024-11-23T11:16:07.939Z\"}}},\"env\":\"production\",\"devEnv\":\"prod\",\"version\":887582,\"versionUpdatedAt\":\"2021-04-23T13:49:15Z\"}", formData: "{\"type\":\"form\",\"elements\":[{\"type\":\"banner\",\"id\":\"cbaac2b8-26bd-5786-97c3-0ab9e07ffee3\",\"legacyPath\":\"header.banner2\",\"backgroundType\":\"color\",\"fullWidth\":true,\"backgroundColor\":\"rgba(255,255,255,1)\",\"imagePosition\":\"center center\",\"textType\":\"custom\",\"customText\":\"<p style=\\\"text-align: center;\\\"><span style=\\\"color: rgb(86, 39, 19);\\\">Click <a href=\\\"#\\\" rel=\\\"noopener noreferrer\\\" target=\\\"_blank\\\">here<\/a> to learn more about our practice and the services we offer!<\/span><\/p>\",\"sticky\":true,\"active\":true,\"visible\":true},{\"type\":\"banner\",\"id\":\"45b9ecb7-ccb7-514e-baa7-882f40647767\",\"legacyPath\":\"header.banner3\",\"backgroundType\":\"transparent\",\"minHeight\":400,\"imagePosition\":\"center 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Where should we send the 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locale: "en", translation: "{\"element.address.label\":[[\"label\"]],\"element.address.label\/billing\":[[\"label\"]],\"element.address.placeholder.AU.postalCode\":\"Postcode\",\"element.address.placeholder.AU.region\":\"State\",\"element.address.placeholder.CA.postalCode\":\"Postal Code\",\"element.address.placeholder.CA.region\":\"Province\",\"element.address.placeholder.GB.postalCode\":\"Postcode\",\"element.address.placeholder.GB.region\":\"Region\",\"element.address.placeholder.US.postalCode\":\"ZIP Code\",\"element.address.placeholder.US.region\":\"State\",\"element.address.placeholder.default.city\":\"City\",\"element.address.placeholder.default.country\":\"Country\",\"element.address.placeholder.default.postalCode\":\"Postal Code\",\"element.address.placeholder.default.region\":\"Region\",\"element.address.placeholder.default.street1\":\"Street Address\",\"element.address.placeholder.default.street2\":\"Street Address 2\",\"element.billing.card.label\":\"Credit 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<0>\",[\"suggestion\"],\"<\/0>?\"],\"element.heading.altText\":[[\"altText\"]],\"element.heading.altText\/billing\":[[\"altText\"]],\"element.heading.text\":[[\"text\"]],\"element.heading.text\/billing\":[[\"text\"]],\"element.name.label\":[[\"label\"]],\"element.name.label\/billing\":[[\"label\"]],\"element.name.labels.first\":\"First Name\",\"element.name.labels.last\":\"Last Name\",\"element.name.labels.middle\":\"Middle Initial\",\"element.name.placeholder.first\":[[\"0\"]],\"element.name.placeholder.last\":[[\"0\"]],\"element.name.placeholder.middle\":[[\"0\"]],\"element.phone.label\":[[\"label\"]],\"element.phone.label\/billing\":[[\"label\"]],\"element.phone.optInText\":\"Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. <0>View our terms of service & privacy policy.<\/0>\",\"element.phone.optInText\/givingfuel\":\"Yes, it's okay to communicate with me by text message. Message frequency varies. Message and data rates may apply.<0>View our terms of service & privacy policy.<\/0>\",\"element.phone.orgLabel\":\"Organization Phone\",\"element.formFeesToggle.add\":\"Add an additional contribution of\",\"element.formFeesToggle.help\":\"to help cover our processing fees\",\"element.formFeesToggle.learnMoreButton\":[\"<0>\",[\"show\",\"select\",{\"yes\":\"Learn More\",\"other\":\"Learn More\"}],\"<\/0>\"],\"element.formFeesToggle.breakdown\":\"Adding an additional small percentage to your donation will help cover our processing fees, ensuring more of your contribution directly supports our mission. 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