Welcome

1

What’s the main thing bringing you here?* This field is required.

Relationship or marriage

Anxiety or stress

A life transition (career, move, loss)

Confidence or self-esteem

Family dynamics

Grief

Something else

2

Tell us a little more in your own words

3

Have you worked with a therapist before?* This field is required.

This is my first time

Yes, and it helped

Yes, but it wasn’t the right fit

I’m currently working with someone

4

What matters most in a therapist match?* This field is required.

Similar life experience

Specific specialization

Communication style or personality fit

Availability that works with my schedule

Gender preference

No strong preference

5

How would you like to meet?* This field is required.Almost there — just a couple more, then you’re set!

Video call

Phone Call

Text

Any of the above

6

Are you currently in crisis or having thoughts of harming yourself?* This field is required.

Yes

No

Prefer not to say

7

Contact Details

First Name

Last Name

Please enter your email

Please enter your phone

8

Anything else that you would like to share?(Optional)

9

Thank you for telling us.

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