With & Within Couples Schedule a Consultation

Thank you for your interest in With & Within Couples. This form is designed only to schedule a 15-minute complimentary consultation (with both partners). Someone will get in touch within the next 48 to 72 hours.

What not to share here:
Please do not include personal or clinical details such as your date of birth, social security number, mental health diagnosis, or specific circumstances that led you to seek counseling. We will go over anything relevant during your first consultation.

Important Information Before Scheduling:

This consultation is intended to assess fit. It does not guarantee the start of a professional relationship.
Dr. Colón reserves the right to accept or decline clients whose presenting concerns fall outside her areas of professional competency or availability, or when, in her clinical judgment, providing services may not be appropriate in order to ensure quality of care and avoid potential harm. In such cases, referrals to other providers may be offered when possible; however, the practice is not responsible for identifying, arranging, or scheduling services with another provider.
An established professional relationship only begins once both partners have signed an informed consent for services.
Because of federal regulations, we cannot provide self-pay services to individuals who have Medicare or Medicaid coverage. Please contact them for a list of participating providers.
To best use our time together, please read the FAQs on our website before scheduling.

Privacy Notice:

Your responses are stored securely under our HIPAA-compliant Google Workspace. However, email is not a fully secure form of communication.

If you prefer, you may call us directly at (305) 363-1458.

Contact Us

Full Name

Email Address

Please provide an email you check regularly

Phone Number

Used only for scheduling communication

Preferred Days / Times for Consultation

Example: “Mondays after 6pm” or “Weekends only.”

How would you like us to contact you?

Email
Phone
Either is fine

Required Acknowledgment

I understand this form is for scheduling only, not for sharing personal or clinical details. I acknowledge that this is a complimentary 15-minute consultation to explore fit and does not represent a professional relationship unless and until an informed consent is signed.

Required Acknowledgment

I have read and agree with the information included in this contact form, including its section "Important Information Before Scheduling".

Required Acknowledgment

I confirm that I have read the FAQs and have the consent and agreement of my partner to inquire about couples counseling services with With & Within Couples.

Required Acknowledgment

I consent to being contacted for scheduling purposes, knowing that while With & Within Couples’ system is HIPAA-compliant, my own email provider may not be fully secure, and I may always choose to be contacted by phone instead.

Optional Acknowledgment to

Optional Marketing Consent

I agree to receive updates, newsletters, or other marketing communications from With & Within Couples. I understand that my consent is optional and can be withdrawn at any time by unsubscribing or contacting the practice directly.

With & Within Couples Schedule a Consultation​

Contact Us

With & Within Couples Schedule a Consultation