Reimagine Life – Client Fit & Readiness Application
Welcome! I'm so glad you're considering support through Reimagine Life. This short form will help us both determine if we’re a good fit to work together. I take a Christ-centered, whole-person approach to counseling. Please answer honestly—there are no wrong answers! I look forward to hearing from you.  (All answers are completely confidential and HIPAA-protected.)
SECTION 1: Basic Information
1. Full Name (only women can apply) *
2. Birthdate *
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3. Email Address   *
4. Phone Number   *
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This form was created inside of Reimagine Life, LLC.