Rewire Wellness 1:1 Session

Your Current Experience
What brings you here? What issue or goal would you like support with?*
How long have you been dealing with this issue?*
What have you tried in the past to resolve this issue?*
Include anything from therapy, self-help, habits, medication/self-medication, or spiritual tools
What were the results of those efforts?*
Be as specific or general as you’d like.
What would success look like for you in our work together?*
Paint a picture—how would you feel, what would change, what would you be doing differently?

Consent
Disclaimer & Agreement. Please check the box below to acknowledge:*

I understand this is an interest form only and does not guarantee services. I affirm that I am seeking wellness support and understand this is not a substitute for medical or psychiatric care.
Thank you for sharing! I’ll review your responses and get back to you within 2–3 business days (or sooner) with next steps for booking and getting started.
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1:1 Session Request