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Schedule Free Consult
Thank you for taking the first step. To ensure our free 15-minute assessment is as helpful as possible, please provide a little information about your situation. All of your responses are confidential.
Welcome to Ellipses
1. Contact Information
Your Full Name:
Email Address:
Phone Number:
How would you prefer we contact you for the assessment?
Phone Call
Video Call
2. About the Situation
Who is the primary person you are seeking support for?
What is their current diagnosis or situation?
How long has your family been dealing with this diagnosis or situation?
Less than 3 months
3-12 months
1-3 years
More than 3 years
3. Your Needs
What are the biggest challenges you're facing right now?
Mental Health Support
Support for yourself or someone in your household reaching their goals
Direct support for a family member
Managing appointments and logistics
Navigating difficult conversations
Dealing with emotional distress
Finding reliable resources or information
Caregiver burnout
Planning for end-of-life
Other:
What kind of support are you hoping to find with our services?
Submit and Schedule My Assessment
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