Thank you for your interest in professional consultation with Dr. Schofield. Please complete the form below so we can better understand your needs and determine whether 1:1 sessions, the Group Mentorship Circle, or both would be the right fit.

Note: This form is for general intake and is not HIPAA-compliant. Please avoid including protected health information (PHI).

Contact Information

Name *

First Name

Last Name

Email *

Phone

(###)

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Professional Background

Current Role / Title *

License Type *

Years of Clinical Experience *

State(s) Licensed In *

Work Setting *

What type of consultation are you interested in? *

(Select all that apply)

1:1 Consultation

Group Consultation & Mentorship Circle

Not sure yet—would like to learn more

What brings you here? *

Briefly describe what you're hoping to receive support around—clinical, professional, or otherwise

Common Topics You’d Like to Explore *

(Select all that apply)

Case consultation (therapy or assessment)

Ethical or boundary concerns

Burnout or decision fatigue

Transitioning to private practice

Identity development or specialization

Operational support (program design, billing, workflows)

Other (please specify)

Are you seeking ongoing support or a one-time consultation? *

One-time consultation

Ongoing sessions

Undecided

Group Consultation Readiness

(if applicable)

Anything else you’d like me to know?

Disclaimer *

This is a general interest form and does not guarantee immediate scheduling. If there's a waitlist, I'll follow up as soon as a space becomes available.

Acknowledged

Thank you!

919 W. 21st Street, Suite B Norfolk, VA 23517

NAVIGATION

Dr. Schofield

Contact

SPECIALTIES

Individual & Family Therapy

Psychological Testing & Evaluation

Professional Consultation

Clinical Supervision

Career Mentorship & Private Practice Incubator

Our Policy

Scheduled appointment times are reserved especially for you and without 24 hours’ notice, it is difficult for us to fill your time slot with another appointment. If an appointment is missed or cancelled with less than 24 hours’ notice, you will be billed according to the scheduled fee policy, at the full cost of the scheduled session.

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