Consultation: Dr Lila's Guidance 1:1 / 3month

1

NamePlease provide your Name

First Name

Last Name

2

EmailThank-you for your email address

example@example.com

3

Phone NumberPlease add your best number

Area Code

Phone Number

4

Have you met for therapy in the past please add the focus of therapy

5

If so, what therapeutic modality did you experience CBT, Motivational Interviewing, Strength based

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What is your immediate challenge

7

Name the top three challenges you want to address short description

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How will you feel when you have complete the 12 Guidance sessions short description

9

What traumatic event in your life would be helpful for me to knowshort description

10

What is your self care routine (personal and professional)short description

11

How much time do you give to others short description

12

What is your favorite color short answer

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Is there anything else I need to know short answer

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What is your most convenient time for your Guidance sessions