Changes Counseling & Mediation

• About Angela Sullivan
• Services & Pricing
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Healthy Change is Possible for Anyone!

Let's Get Started!

Questions or Comments?

Simply complete the following form, and I will contact you regarding the various Services and Pricing packages available. You may also contact me directly via email, or call 816-229-2760. You can also review my Professional Disclosure Statement for additional information.

Your Name:
E-mail Address:
Telephone Number:
First name of an emergency contact and their phone number and/or local law enforcement:
Issues wanting help with:
I have Read and Agreed to the Informed Consent to Treatment and Notice of Confidentiality document.

Paperwork

Prior to our sessions, please download, print and complete the relevant paperwork:

• Professional Services Contract [Adobe PDF, 61Kb]
• Counseling – Intake Questionnaire [Adobe PDF, 48Kb]
• Mediation – Client Personal History and Background [Adobe PDF, 36Kb]

Payment for Services

Counseling Sessions

If you wish to prepay for counseling sessions, please use the following PayPal link:

Mediation Sessions

If you wish to prepay for mediation sessions, please use the following PayPal link:

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