Newbie Application for 1:1 Consultation

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Hey, there! So glad you're interested in working with Dr. Kate!

Please fill in your best answers to the following questions so that Dr. Kate can get a sense of your concerns, situation, and readiness to get started.

IMPORTANT NOTE: if Dr. Kate accepts your application, you will be able to provide more detailed responses during the intake process. Feel free to keep your responses to 2-3 sentences.

We're excited to meet you! 🤩

Email *

Name *

First and last name

Phone number *

Street Address *

City and State *

Country *

In 2-3 sentences, why did you decide to apply to work with Dr. Kate? *

In 2-3 sentences, what obstacles or challenges are getting in the way of your whole-person health & well-being? *

In 2-3 sentences, why is now the right time to tackle your issues? *

Have you tried anything else to address this concern? If so, please briefly summarize strategies you've tried? If not, why not? *

What 1-3 goals do you have for working with Dr. Kate? *

Are you ready to invest in addressing your concern? Time, money, and effort? *

Is there anything specific you'd like Dr. Kate to know while reviewing your application?

How did you hear about Dr. Kate?

Send me a copy of my responses.

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This form was created inside of KMLD Wellness.