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Welcome to the beginning of your mindful journey!
Please answer a few questions below so I can learn how to better service you! ~Nikki Nu
12
Questions
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1
"As I walked out the door toward the gate that would lead to my freedom, I knew if I didn't leave my bitterness and hatred behind, I'd still be in prison" ~Nelson Mandela.
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2
How did you hear about our services?
Word of Mouth
Instagram
Newsletter
Facebook
TikTok
YouTube
Pinterest
Twitter
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3
Name
*
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First Name
Last Name
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4
Email
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5
Preferred Contact Method (email/sms)
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6
Phone Number
Please include if SMS is your preferred
Please enter a valid phone number.
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7
Ethnicity you associate with
African American, Asian, etc
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8
Have you been to therapy before?
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YES
NO
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9
If you answered yes, how was your therapy experience?
Great
It wasn't the best.
Other
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10
I am not a licensed Mental Health Professional is that ok?
*
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Although I do have my degree, BA Psychology and professional experience within the mental health field as a case manager and plus more.
YES
NO
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11
Aside from mindfulness, was there anything else in particular you'd like us to discuss or cover?
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12
Is there anything you'd like to avoid?
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I.E (prefer to keep your camera off, in an abusive relationship and need to be discreet). Please advise so that I can be mindful in creating a comfortable environment for you :)
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13
When are you available to meet virtually?
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