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We’ll match you with the best therapist and send you scheduling options! If you are in crisis, do not use this form - instead call 911, 988, or go to your nearest emergency room. We are unable to respond to urgent requests or emergencies.

Name

First Name

Last Name

Phone

(###)

###

####

Who are you seeking therapy for?

Individual therapy for myself

Couples/sex therapy for me and my partner

What type of services are you interested in?

Preferred appointment time:

I'd like to work with:

Message

What else would you like for us to know?

I understand that:

Sea Glass clinicians are only licensed in Ohio and I need to be physically located in Ohio at the time of service. Sea Glass does not accept insurance and cannot bill my insurance company directly. Sea Glass only offers virtual therapy and that all services are provided to adults in Ohio via telehealth.

Yes

Contact Us

Mailing Address: Sea Glass Counseling and Consultation
545 Metro Place S, Suite 100, Dublin, OH 43017

Fax: Sea Glass does NOT utilize faxing. Please send any materials needing faxed to our HIPAA-compliant email: hello@seaglassohio.com