Intake form

Help us serve you better

Name *

Email address *

What service are you interested in?

Have you previously worked with a coach or healer?

If yes, please describe your experience.

What are your primary goals for seeking support?

How did you hear about NotMyTherapist.com?

Please select at least one option.

Social Media

Friend or Family

Search Engine

Online Ad

Do you have any specific concerns or issues you would like to address?

What is your preferred method of communication?

Are you comfortable with virtual sessions?

Additional questions or comments

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