What is Your Name (First & Last)?
What is Your Pronoun?
What is Your Email Address?
What is Your Phone Number?
Which Issue Best Fit Your Concern? (Select All That Apply):
(1) Depression
(2) Anxiety
(3) Trauma
(4) Work-Related Stress
(5) Race-Related Stress
(6) Other
In A Few Words, Tell Me Your Goal(s) For Therapy?
Are You Looking For A Therapist Who Is Comfortable With Bringing Your Cultural Background Into The Therapy Room?
Is This Your First Time In Therapy?
Are You Looking To Better Understand Yourself And How You Relate To Others?
Are You Ready To Take A Therapeutic Journey Where You May Be Challenged In Exchange For Personal Growth?
How Long Do You Think You Will Be
Committed
To Therapy?
(1) A Few Sessions
(2) Until My Issue Is Resolved
(3) I Have A Lot To Unpack And Discover
Send Answers
