Greenville Contact | Legacy Services

top of page

Use tab to navigate through the menu items.

Please complete this form the best that you can to be placed with a therapist

Reason(s) for Seeking Therapy:

Grief

Anxiety

Depression

Sexual Abuse

Low Self-Esteem

Couples Therapy

Sex/Porn Addiction

Vaginismus

Sexual Trauma

Suicidal ideations

Spiritual Conflict

Infidelity

Dyspareunia

Low Self-Worth

Interpersonal Conflict

Sexual Intimacy Challenges

PTSD

Racial Identify

Other

Would you like your therapist to be a specific race? Religion? Or gender identity? etc.

Thanks for submitting!

201 S. Skinker Blvd. St. Louis, MO 63105

Tel 314-328-1757

bottom of page