We are very pleased that you have made the decision to begin your healing process. By filling out the form below and thereby reaching out to JCW, you can join many survivors of sexual abuse who, through willingness and perseverance, have not only been able to blossom into healthy individuals, but also become an inspiration to many others. 

We know that reaching out for help can be difficult. Please remember that many of us at JCW are survivors of abuse who have felt the pain, guilt, and shame you may be experiencing. We know that it takes a tremendous amount of bravery and courage to make the choice to heal and we therefore applaud you for your decision. We assure you that we will be here along the way to support you, love you, accept you, and travel with you. We only ask that you let us help. 

All information you provide will be kept strictly confidential. Once the form is submitted, someone from JCW will reach out to you to connect you with a therapist that best suits your needs. Please note that the information provided here will be used to match you with an ideal therapist and should therefore be completed as thoroughly as possible.

Please fill out any other information you feel will be relevant in assigning the right counselor to you (e.g. description of symptoms, past history in therapy, etc)