How did we do?

Intials

First Name

Last Name

By checking the boxes I authorize that: *

I have received counseling or other mental health and wellness services from Bridging Bonds.

I give Bridging Bonds permission to post the first and last initial of my name next to my Testimonial on Provider’s website and to use this information elsewhere for marketing purposes.

I request that NEITHER initials be included with my Testimonial on Provider’s website. Bridging Bonds may post my Testimonial on Bridging Bonds website and elsewhere for marketing purposes, but may not list my initials.