Consult with Matana
Please fill answers to all ALL questions. All responses will only be viewed by Matana personally and be completely confidential.
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Email *
How did you hear of Hope to Recharge?
What is your first and last name? *
What is your gender? *
How old are you? *
What is your current marital status? *
Do you believe in a person's ability to change? *
Do you believe in the process of energy healing /positive mindset? *
Do you have big dreams in life? *
Have you had or are you in professional therapy, counseling or holistic healing sessions? If yes, Please elaborate. *
What is your big mental health goal? *
What would you like to achieve by working with Matana? *
What do you feel is the biggest obstacle in your journey to healing?
What do you practice daily in order to improve your mental health?
What inspires you?
Have you ever experienced joy in the past? currently?
Are you aware that the process of healing takes time and much work?
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Are you willing to start the process of healing now and do the best you can, or is it too difficult at this time?
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Disclaimer: By submitting this form, you confirm, understand and acknowledge that Matana, the Company, their affiliates, nor any of their respective employees, agents, third parties, or licensors are not medical health professionals and are not qualified or licensed to offer professional medical advice, nor are any assertions made, either suggested, implicit or otherwise, that she/they can diagnose, treat, cure or prevent and disease or diagnosis and have not been retained in any legal, formal or informally bound doctor/patient relationship. Any advice or suggestions given at any point, should be reviewed prior to implementation with a medically qualified and licensed health professional and you agree to the terms and conditions as stated in the link above. *
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Please enter your cell phone telephone number so that we may contact you via Text message to confirm appointments  or in the event our emails to you bounce back. (No calls or spam) *
A copy of your responses will be emailed to the address you provided.
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