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Application for Mental Wellness Consultation
Email address *
Name *
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Job Title
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Phone number *
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What would you describe your current stress level? (from 1 to 10) *
How long have you been experiencing this? *
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Please briefly describe how it is impacting your work and life? *
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What have you tried to help with things? *
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What do you specifically need help with? *
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What do you ultimately want to experience if you were completely stress feel, high motivated and feeling fulfilled? *
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How much time and effort are you open to investing to improve your situation? *
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Comments: What else would be important for us to know about you?
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What service(s) are you most interested in? *
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