Name *

First Name

Last Name

Phone

(###)

###

####

Yes, I’d like to be contacted via email with a response to this form, and to receive occasional emails with mental health and relationship tips, special offers, and workshop announcements from North State Family Counseling Center, Inc. I understand I can unsubscribe at any time. NSFCC does not share or sell your information to any third parties.

Please select the services that interest you. *

Weekend Couples Workshop

6 -week Couples Group

Couples Private Intensive

Individual Private Intensive

Weekly Women's Bibliotherapy Group (Mental Health Book Club Style)

Wilderness/Outdoor Therapy Group

Women's Weekend Retreat

Custom Presentation, Workshop or Seminar for your Company, School, Church, Organization, Etc.

Individual Weekly Therapy- Virtual

Individual Weekly Therapy- In-person

Other

YES! I'd like to enter the drawing for a free ticket to the June 28-29th, 2025 Couples Workshop at the Best Western Hilltop Inn in Redding, CA. Entry Deadline is June 8th, 2025 at 11:59pm

Which times of day generally work best for you to attend sessions, workshops, or events?

Weekday Morning

Weekday Afternoon

Weekday Evening

Weekend Morning

Weekend Afternoon

Weekend Evening

Other