Intake and Assessment form

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Unalome Caribbean Consulting offers culturally grounded mental health and coaching services across the Caribbean. We provide individual and group counselling, sex and relationship coaching, and organizational support focused on leadership, team building, grief and trauma, and intercultural competence. Our work blends evidence-based psychological practice with deep cultural awareness, helping clients and organizations build the skills, insight, and strategies they need to grow, heal, and function at their highest potential.

Name

Age

Gender

Cis Man

Cis Woman

Transgender Man

Transgender Woman

Gender Non Conforming

Non Binary

Bi Gender

Prefer Not to Say

Other:

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Contact information

(Please include your phone number with country code and email address)

What service(s) are you requesting?

Individual Therapy

Couple's Therapy

Life Coaching

Sex Coaching

DEI work -LGBTQI

DEI work -cultural competency

DEI work- racial compentency

DEI work- tackling sexism and misogyny

Have you seen a psychologist before. If so indicate what was the prevailing issue

What factors have brought you to request this service ?

How urgently do you need services? *

Its an emergency

I am able to wait at least 24 hours for a response

I want to set up a chemistry call to see if this will work for me

Any other information you think we should know

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