Register for Workshop

Woman on couch holding laptop engaging in online therapy.

Thank you for your interest in our workshop! We accept most major insurances. Please reserve your spot by filling out the required registration information below and we will be in touch with you. If you have any questions or would like to discuss self-pay options, please contact Jill at Jill@EmeraldCoveCounseling.com – Thank you!

Name(Required)

First Last

Date of Birth (xx/xx/xxxx)(Required)

Phone(Required)

Email(Required)

Upload Insurance (Front)(Required)

Max. file size: 64 MB.

Upload Insurance (Back)

Max. file size: 64 MB.