Step 1 of 5
Let's start with you.
Tell us a little about yourself. All information is kept strictly confidential.
Please enter your first name.
Please enter your last name.
Please enter a valid email address.
Emergency Contact (optional)
How did you hear about us?
Step 2 of 5
What brings you here?
Select the service(s) you're interested in. You can select more than one — we'll figure out the best fit together.
Step 3 of 5
Tell us about your situation.
The more context you can share, the better prepared we'll be for our first conversation. All of this is confidential.
Child / Student Information (if applicable)
Step 4 of 5
Agreements & Consents
Please review each item below and toggle on to confirm your agreement. These can be discussed and finalized in our first session — this is your initial acknowledgment.
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Not binding yet: These are preliminary acknowledgments for intake purposes. Complete, signed agreements will be provided before services begin.
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Your information is submitted securely and directly to Jennifer Fischer. It is never sold, shared, or used for any purpose other than providing you with services.
Step 5 of 5
Review your information.
Please take a moment to review before submitting. You can go back to edit any section.
Final confirmation
Ready to submit?
By submitting this form, you confirm the information above is accurate and that you've reviewed and agreed to the items in Step 4.
Please type your full name to confirm.
✓
You're all set, .
Your intake form has been submitted successfully to Jennifer Fischer at Common Ground Collective.
You'll receive a confirmation email shortly, and we'll be in touch within 1–2 business days to schedule your consultation.