Name * First Name Last Name Email Address * Subject * Message * Disclaimer * I understand and agree that any information submitted will be forwarded to the office of Rehope Counseling, PLLC by email and not via a secure messaging system. This form should not be used to transmit private health information, and Rehope Counseling, PLLC disclaims all warranties with respect to the privacy and confidentiality of any information submitted through this form. I understand that by submitting this form I am consenting to being contacted via phone or email by Rehope Counseling, PLLC. Agree Thank you! Rehope Counseling will be in contact with you by the end of the next business day.If this is an emergency please call 911.