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Preferred Method of Contact
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Phone Call
Text Message
Email
Which type of support are you interested in?
Behavioral Health Support
Peer Support
Life Coaching / Mindset Coaching
Not Sure Yet – I’d like to talk it through.
What brings you here today?
Are you currently working with another therapist, coach, or support program?
Yes
No
Prefer not to say
Preferred Days/Times for a Call or Session
Weekdays AM
Weekdays PM
Weekends
Flexible
Age Range
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13–17
18–25
26–40
41–60
60+
How did you hear about us?
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Instagram/Facebook
Referral
School / Organization
Event
Other
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