Membership Cancellation Form

Cancelling your subscription can be easily done online. You can cancel future subscription payments online by clicking "Quit Counseling" below and completing the cancellation form. You’ll know that your membership has been ended when you receive the confirmation email with the subject “Goodbye for now ”.

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Who is your counselor?(Required)

This field is hidden when viewing the form

How would you rate your experience with MyCounselor? (not active)

5-Star4-Star3-Star2-Star1-Star

How would you rate your experience with MyCounselor?(Required)

1-Star

2-Star

3-Star

4-Star

5-Star

Are you interested in a FREE session to try a different counselor?(Required)

Yes!

We want to help you reach your goals. No counselor is a perfect fit for everyone. If you haven't reached your goals yet we'd like to offer you a free session with a different counselor.

Awesome!

Press "Next" and our Matching Specialist team will contact you to help you match with a new counselor for your free session. Your memberships will continue for now. If it does not work out, you can still cancel your membership at any time by completing this form again.

Did you achieve one or more of your goals for counseling?(Required)

Yes

On a scale of 0 to 10, how likely are you to recommend MyCounselor.Online to a friend or family member?(Required)

0	1	2	3	4	5	6	7	8	9	10

We'd love to hear about your experience and how you think we can improve.

Post-Assessment

Assessment Question #1(Required)

Please imagine a scale with values from 0 to 10. Number 10 represents the happiest possible life for you and 0 represents the unhappiest possible life for you. On which number of the scale would you say you personally feel you are at this time?

Assessment Question #2(Required)

On which number of the scale do you think you will feel you are at about five years from now?

Future Sessions(Required)

How would you like us to handle any future sessions you already have scheduled?

Cancel all scheduled upcoming sessions.

I plan to attend all upcoming sessions. *Please do NOT cancel my upcoming sessions.*

I understand...(Required)

- All charges prior to my cancellation are non-refundable.

- My spot on my counselor's caseload will be filled and I may have to go on a waiting list or work with another counselor if I resume my membership.

- I have 12 months after cancellation to use any remaining session credits on my account; after that they will be donated to a scholarship fund for pastors, missionaries, and foster parents.

- If I continue to schedule appointments after all my session credits have been used, I will be charged the non-member rate

I understand.

Comments

This field is for validation purposes and should be left unchanged.

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Post-Assessment

Credentials

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Membership Cancellation Form

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Post-Assessment

Credentials

Evidence-Based Therapy

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