Application Form Name * First Name Last Name Email * 1. Have you ever received a formal diagnosis of any mental health condition? If yes, please provide details. * 2. Are you currently receiving any form of therapy or counselling? If yes, please provide details. * 3. Do you have any specific concerns or topics you'd like to address in our work together? * 4. Have you ever experienced any adverse reactions or challenges during previous therapy, counseling, or personal development work? If yes, please provide details. * Thank you!
