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FORMS

We will let you know if filling out these forms is necessary for our work together.
Thank you!

Informed Consent

Safety Process

Informed Consent for Telehealth

Cancellation Policy

Rights & 
Responsibilities

Release of Information

For CCS and CCF clients

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Click below for the Referral Form

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CONTACT US

We are currently accepting new clients for individual grief support, grief/loss Circles, long-term projects,
and strategic partnerships.

 

Please call me (Jessie) at 608-347-1432 and leave a detailed message and a good time for me to return your call. 

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We will begin with you over the phone with a “needs assessment.” During this call, we learn more about your needs and intended outcomes for services.

 

Rate Breakdown:

  • The needs assessment by phone takes around 30 minutes to one hour, and is free of charge.

  • Rates for all services is dependent upon the scope of work requested.

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You can pay via cash, check, or by clicking the "donate" button below (which allows you to pay with PayPal, or a credit/debit card.)

  Contact Information. 

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 Email: collectivevoices2019@gmail.com 

  Phone: 608-347-1432   

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Mailing address:
1121 N. Johns St. 

 P.O. Box 243 

 Dodgeville, WI 53533

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Thank you 
for submitting!

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