Request A Consultation

You are requesting a consultation with a mentor from LPCA. Please fill out the following information to the best of your ability.

This is the non-member consultation form. If you are a member, please exit this page and log in to request a consultation. Members receive consultations for free as a member benefit.

Contact Information

First Name *

Last Name *

Phone *

Email *

Please use the email address associated with your LPCA account (if applicable).

Reason for Consultation *

Please describe the situation *

Attach all relevant documentation (if applicable)

Mentors may request additional documentation if needed

Please indicate: *

I have a supervisor

I am in school/not working under supervision

I am fully licensed

Please list your supervisor(s)

This information is confidential. Please list your Supervisor's full name, licensure number, and credentials (CPCS/ACS). This can help speed up your consultation process.

Consultation Scheduling

Which days are you available for a consultation? *

Please select all that apply.

What time of day are you available for a consultation?

Please select all that apply.

Terms and Conditions

Mentor Matching and Availability: We will make every reasonable effort to match you with a mentor whose skills, experience, and availability align with your consultation needs. However, mentors consist of both staff and volunteers, and matching availability cannot be guaranteed. Appointment times may not align with your preferred schedule, and we are unable to guarantee consultation availability within specific timeframes.

Consultation Scheduling Process: Once your request has been processed, you will receive an email with available appointment options. You may select from the times provided. Due to the high volume of consultation requests, our response time may take up to 14 business days, during which you will receive communication to schedule your consultation.

Appointment Timing: Because mentors’ schedules vary and volunteers often maintain full-time practices, scheduled appointments may be 1–6 weeks from the date of scheduling, depending on availability. While we strive to accommodate all requests as promptly as possible, no guarantee of consultation fulfillment time is provided.

Consent to Share Information: By checking the consent box, you authorize LPCA to share your contact information and any materials you provide with LPCA staff and volunteer mentors solely for the purpose of facilitating your consultation. You also authorize LPCA and its mentors to use your contact information to communicate with you regarding scheduling, updates, and matters related to your consultation.

I acknowledge and agree to these Terms and Conditions. I understand that consultation scheduling is dependent on mentor availability and that response or appointment times cannot be guaranteed.

I consent to have my name, contact information, and any provided materials shared with LPCA staff and volunteer mentors for the purpose of facilitating my consultation. I authorize LPCA and its mentors to use my contact information to communicate with me regarding scheduling, updates, and matters related to my consultation.

Click the checkbox next to "Non-Member Consultation" below to pay and submit. *

Non-Member Consultation

$75

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