Name *

(Legal or Preferred)

First Name

Last Name

Check off any issues that may be beneficial for us to focus on: *

Chronic Stress

Navigating a BIG life change

Anxiety

Depression

Behavioral Addiction

Developing coping skills

Increasing self awareness

Setting more effective goals

Confidence, self-esteem + support

Grief + loss

Sleep issues

Managing Substance Use/Abuse

Maintaining Recovery