{"id":20,"date":"2020-12-27T00:11:36","date_gmt":"2020-12-27T00:11:36","guid":{"rendered":"https:\/\/olivebranchcounselingservices.com\/?page_id=20"},"modified":"2024-09-19T18:35:02","modified_gmt":"2024-09-19T22:35:02","slug":"contact","status":"publish","type":"page","link":"https:\/\/olivebranchcounselingservices.com\/es\/contact\/","title":{"rendered":"Contacto"},"content":{"rendered":"\n<p style=\"font-size:22px\">For a free 15-minute consultation, please fill out the form below: <\/p>\n\n\n\n<p>Please note that all services are being conducted virtually due to the COVID-19 pandemic. <\/p>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-44aa31d1-1ea2-4084-aa0c-3aea75656ae0\" id=\"wpforms-63\"><form id=\"wpforms-form-63\" class=\"wpforms-validate wpforms-form\" data-formid=\"63\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/20\" data-token=\"51dc393308a39ec6ade64412653cb1ec\" data-token-time=\"1782510718\"><noscript class=\"wpforms-error-noscript\">Por favor, activa JavaScript en tu navegador para completar este formulario.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-63-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-63-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-63-field_0\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-63-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-63-field_0-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/div><div id=\"wpforms-63-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-63-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-63-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-63-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-63-field_3\">Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-63-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" step=\"any\" required><\/div><div id=\"wpforms-63-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><label class=\"wpforms-field-label\">How should I contact you? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-63-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-63-field_6_1\" name=\"wpforms[fields][6]\" value=\"By email\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-63-field_6_1\">By email<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-63-field_6_2\" name=\"wpforms[fields][6]\" value=\"By phone\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-63-field_6_2\">By phone<\/label><\/li><\/ul><\/div><div id=\"wpforms-63-field_4-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-63-field_4\">Brief description of why you are seeking therapy (e.g. parenting concerns, child behavior, general anxiety or depression) <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-63-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/textarea><\/div><div id=\"wpforms-63-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-63-field_2\">Please indicate your preferred days\/times for sessions <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-63-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/textarea><\/div>\t\t<div id=\"wpforms-63-field_8-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"8\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-63-field_8\" >depression) concerns, current<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-63-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-63-field_5-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"5\"><label class=\"wpforms-field-label\">Are you (or is the patient) a current resident of the state of Maryland? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-63-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-63-field_5_1\" name=\"wpforms[fields][5]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-63-field_5_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-63-field_5_2\" name=\"wpforms[fields][5]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-63-field_5_2\">No<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Please note that I am only licensed to work with individuals in Maryland at the time of service. <\/div><\/div><div id=\"wpforms-63-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><label class=\"wpforms-field-label\">Are you currently insured by any of the following (and would utilize them as payment for treatment)?<\/label><ul id=\"wpforms-63-field_7\"><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-63-field_7_6\" name=\"wpforms[fields][7]\" value=\"Aetna\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-63-field_7_6\">Aetna<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-63-field_7_2\" name=\"wpforms[fields][7]\" value=\"Carefirst BlueCross BlueShield\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-63-field_7_2\">Carefirst BlueCross BlueShield<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-63-field_7_1\" name=\"wpforms[fields][7]\" value=\"Cigna\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-63-field_7_1\">Cigna<\/label><\/li><li 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