Referral · Joint session

Refer a joint counseling session

For agencies, clinics, or the parties themselves to request a joint counseling session for intended or recipient parents and their gestational carrier or directed (identified) donor. Prefer email? Send details to rachel@rgoldbergtherapy.com.

01Your contact
Add a name and email so we can follow up.
Session type*
Choose one.
Who requires the session?*
Choose one.
Required.
02PartiesParent 1
First and lastAdd their full name.
Add a valid email.
Add a phone number.
Parent 2 (leave blank if a single parent)
Add a valid email.
Gestational carrier or directed (identified) donor
First and lastAdd their full name.
Add a valid email.
Add a phone number.
Required. This decides which clinician can see them.
Required. This decides which clinician can see them.
03Report and billing
Name and email for each recipient.Add at least one recipient.
Write "on file" if we already have your billing contact.Add a billing contact, or write "on file".
04Anything else
Required fields are marked *.
✓

Referral received

Thank you. We will reach out to coordinate the session and send intake forms.