Name *

First Name

Last Name

Phone *

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Consent to Privacy Policy *

I understand that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information I include in an email can be intercepted and read by other parties besides the person to whom it is addressed. I also understand that a counselor from Know Your Worth Counseling will coordinate initial contact, in which I give them permission to leave me a message at the phone number or email address provided.

I have read, understand, and agree to the privacy policy.