Please note that I offer this service free for those who are marginalized
and experience racism.
Diagnosis Navigation Support Form
Thank you for your interest in this free one-off session! This form will help me understand how best to support you. Your responses will remain completely confidential.
Basic Information
For communication purposes.
Full Name
*
First Name
Last Name
Your pronouns
e.g., they/them, she/her, he/him, none
Email Address
*
example@example.com
Your Current Situation
To better understand you.
1. What inspired you to seek support?
e.g., symptoms you've been experiencing, challenges you've faced, or other reasons
2. Do you already suspect a specific diagnosis?
e.g., ADHD, Autism, or other neurodivergences
3. What concerns or fears do you have about the diagnosis process?
e.g., stigma, costs, finding an inclusive provider, overwhelm, fear of being dismissed, etc.
4. Do you feel your experience is influenced by marginalization and racism?
*
Please share only what you feel comfortable with
Our Work Together
To design our session for your needs.
5. What kind of support would feel most helpful during this session?
e.g., practical steps, emotional support, self-advocacy tips, understanding the process, planning, etc.
6. How would you like to meet?
Video call
Audio call
7. Is there anything else you'd like me to know before our session?
e.g., sensory needs, communication preferences, tech accessibility, etc.
By submitting this form, you confirm that you’re seeking a free one-off session to support your diagnosis navigation process. You understand this is not medical advice but a supportive session to empower you in your journey. You also agree to receive emails regarding your session. Do you agree to this?
*
Yes
Submit
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