Contact Us

Address: 350 East Broadway, Jackson WY
Phone: (307) 690-2153
Email: Info@jhfamilysolutions.com

We will respond to your request within 24-48 hours.

Name*
First Last
Date
MM slash DD slash YYYY
Email*
Please provide a valid email address so we can reply
Phone*
Type of Therapy*
Please indicate which type of therapy you are seeking.
- Select All
- Individual counseling
- Couple's therapy
- Family therapy
How did you hear about JHFS?*
- Web
- Returning Client
- Medical Referral
- Family/Friend Referral
- Word of Mouth
I have the following insurance:*
- BlueCross/BlueShield - JHFS is participating provider
- Other - payment due at time of service & JHFS will provide invoice
- None - self pay
PreScreening:*
- Substance MisUse/Addictions has been an issue
- Substance MisUse/Addictions is a CURRENT issue
- Infidelity is/has been an issue
- Domestic Violence is/has been an issue
- Family of Origin Trauma
- Diagnosed Mental Illness is/has been an issue for self or partner
- None of these apply
Reason For Seeking Treatment*
Please briefly outline your reasons or events that lead you to seek therapy at this time as well as any goals you may want to reach through therapy.
Scheduling
Please indicate if you have scheduling requirements or requests. We will do our best to accommodate and appreciate your patience in scheduling.
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