Grace Tree Counseling Services



Your Best Resource For Online Counseling





Order Services Now!

Your information is safe using our secure order form.

In ordering services you agree with the following:

You are 18 years of age or older
You are authorized to use the following credit card account
You have read and understand the applicable fees, service benefits and
     limitations, and Privacy Agreement listed on the website
You are not actively suicidal or a threat to others


Please continue by providing the following information.

Note: Items with a star* are necessary to process your request. All other fields are optional (though helpful), and either an e-mail address or phone number is required to contact you.

*First Name
*Last Name
*Address (Must match billing address)
Marital Status
*Credit Card Number   Visa, MasterCard or Discover.
*Expiration Date (Billing will show as "COIN Services")
*CVV (Number on back of MC/VISA. See below.)


*I'd like to order the following services:


E-Mail Counseling 

Direct Chat Counseling

Telephone Counseling

  1 Session      3 Sessions      5 Sessions

                           (5% Discount!)  (10% Discount!)

   $50       $145     $225

   $50       $145    $225

   $50       $145    $225

 *Choose a chat client and provide your screen name (for direct chat services only).

  AOL AIM                  ICQ

  MSN Messenger    IRC


 *Screen Name 


I'd like my initial contact to be by:

  E-Mail  Telephone


The following section is designed to serve you better. 

Tell us why you are seeking services at this time:

Please list any previous counseling experiences, hospitalizations, diagnosis

 or other treatment received.  Was it a positive experience? Please explain.

Describe any problems you are having in your relationships. Marriage, family, friends, etc.

Lastly, are you experiencing any feelings or thoughts of harming yourself or others?

 If yes, please explain.

Please add any additional comments here .

Thank you for choosing Grace Tree Counseling Services. We look forward to serving you!