Thank you for contacting Raise Up Counseling PLLC.

Please fill out the information below to request your free consultation!

Full Name

First Name

Last Name

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Email

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Address

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Address 2

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Please list your available dates and times for therapy sessions.

Please explain the reason you are seeking help at this time.

Please note that email is not a secure form of communication. Only provide information in this form that you feel comfortable being sent via email. Our sessions and my client portal are confidential methods of communication, which we can use to discuss further details about why you are seeking therapy. If you are uncomfortable fully describing your reasons for seeking services, please let me know and provide just enough information about why you are seeking care at this time. Thank you!

I plan to pay for therapy through:

Wellmark/Blue Cross Blue Shield (BCBS)

Private Pay

If this is a medical or mental health emergency, please call 911 or go to your nearest emergency room or psychiatric urgent care.

This contact form is not a substitute for adequate crisis care.

Thank you for contacting Raise Up Counseling PLLC.

Please fill out the information below to request your free consultation!

Alex Johnson, Counselor, MS, LMHC

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