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Let's Get to Know You!

Hey there!

We’re so glad you’re here. This little form will help us understand how best to support you (or your little one). Take your time, share what feels comfortable — we’re listening

About You

First name

Last name

Pronouns

she/her

he/him

they/them

Other

Age (you or your child)

Phone

Where do you live? (just your area/locality is fine!)

In Case of Emergency

(We hope we’ll never need this, but just in case!)

Emergency Contact Name

Your relationship with them

Phone

Another number we can try (optional)

What brings you here?

Are you looking for support for:

Yourself

Your child

Your Family

What’s on your heart or mind? What made you reach out to us?

Have you done therapy before?

Yes

Nope, this is my first time!

If yes, want to tell us a bit about it?

Health & History

Any big illnesses, diagnoses or health stuff we should know about?

Are you taking any meds — especially ones for the mind or mood?

A Bit of Your Story

Any life moments that have shaped you? (Wins, losses, memories, milestones — whatever feels important to mention.)

Hopes & Intentions

What are you hoping for from this journey?

If this space could offer you something magical or meaningful, what would that be?

Take a deep breath — you did great

Whenever you’re ready, hit submit.

We’re looking forward to meeting you.