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First name

Last name

Your email

Phone number

Age (please note I only work with 18+)

Where are you located?

How did you find me?

Tell me a little about what you are looking to work on in therapy, and any goals and expectations you have from our sessions

Have you previously worked with a therapist? If so, can you tell me a little about, what you worked on, how you found it, what helped, what did not help, as well as any previous mental health diagnoses you may have received

Are you on any medication or have any medical conditions? If yes, please list the name and reason for taking below

Is there anything you feel important to share with me to help prepare for our sessions?

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Please note that I only work with 18+
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Contact

Get in touch with me

Contact form

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Contact