Questionnaire
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Start your Journey

Please tell us how we can help you.

If you have any questions, reach out here.
Step 1 of 3
Start your journey.
Start your Journey

Fill out the entire questionnaire and take the first step.

Patient's First Name *
Patient's Last Name *
Email *
Patient's Date of Birth *
Must be 12 years or older
Guardian's First Name
Guardian's Last Name
Guardian's Date of Birth
Phone *
* Required
Your Address *
Payment Method *
If you have any questions, reach out here.
Lets check your eligibility.
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Step 2 of 3
How can we help?

How can we help you?

What gender do you identify with?

Have you been in therapy before?

What gender would prefer for your therapist?

Which type of therapy are you interested in?

If you have any questions, reach out here.
Step 3 of 3
Select pricing plan

Answer just a few more questions.

1. Have you been diagnosed with a mental health disorder, and if so, what is it?
2. What are your goals for therapy?

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3. Are there any religious or spiritual practices that are important to you in the context of your healthcare?
4. What are your fears about therapy?

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