1-on-1 session
By completing this form you are joining our waiting list for an individual session. We will call you as soon as possible to decide together how we can collaborate in the best way for you. The questions below will help us gain a comprehensive understanding of your current situation, your mental health and your specific needs and goals, so that we can serve in the best way possible. 
*All the information you share is confidential.
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name: *
age: *
e-mail: *
cellphone number:
 *
where do you live? *
your timezone: *
What is your primary reason for wanting to start one-on-one sessions? *
Have you ever had any form of healing or therapy in the past? *
If yes please define the king of healing you received and its results for you.
Are you willing to commit to your healing and be consistent in your appointments and payment? *
Select your prefered payment method: *
Have you ever been diagnosed with mental health conditions? *
If yes please specify:
Have you ever been taking medication for mental health reasons? *
If yes please specify:
Is there anything else you want us to know about you?
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