Contact Modern Love Counseling

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

*IF YOU DO NOT HEAR BACK FROM US IN 48 HOURS, PLEASE TEXT AT 303-900-8514 OR EMAIL ALYSHA@MODERNLOVECOUNSELING.COM. Thank you!

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:

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

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

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