New Client Application
What is your first and last name?
At what email address can we reach you? *This does not automatically sign you up for our newsletter. This is only to be in touch about working together. If you would prefer to be contacted by phone, please include your phone number.
What is your goal in working together? The more detail you are able to give, the more I can follow up on and the more you can get out of our initial session.
What challenges are you facing that lead you to contact us?
Tell me about your current situation including any details about your health that would help me to understand your circumstances better.
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