Let’s connect Please complete this form to inquire about your first appointment Contact Cindy ReynoldsAsafeplacetherapyks@outlook.com(316) 204-8293 Name * First Name Last Name Email * Phone * (###) ### #### Please leave a brief description of what you are seeking help with. * I am interested in online therapy I am 18+ years of age I have received your form and I will get back with you very soon. I look forward to getting to know YOU! Thank you for choosing A Safe Place Therapy. Sincerely,Cindy