Name

First Name

Last Name

What pronouns do you use?

(e.g., she/her/hers, he/him/his, they/them/theirs, etc.)

Phone

Preferred Date & Time to be Contacted

What would you like to speak with Dr. Celestial about?

Clinical Consultation or Coaching (for therapists and health care workers, etc.)

Education, Training, or Workshops for your organization

Speaking Engagement

Psychotherapy in California only (**more info below)

Author’s Visit or Panel

Other (please specify in Message below)

Message

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Submit" you agree to hold Dr. Jeannie Celestial harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Thank you for your interest in connecting! May you be well!

Contact

**Psychotherapy is offered in California only. Therapy inquiries can be made directly to Sweet Mango Therapy Group or by calling (925) 665-3668.

We embody our heritage through how we live our lives each day. Celebrating our heritage during a time of pandemic, we must also honor our bodies, minds, and spirits holistically.

— Dr. Jeannie Celestial