First Name

Email *

Phone

What brings you to therapy? (check all that apply) *

Anxiety or constant worry

Stress or burnout

Relationship Issues

Life Transitions

Trauma or PTSD

Grief or loss

Relationship struggles

Identity exploration

Depression or persistent sadness

Low self-esteem or self-worth

Feeling overwhelmed or stuck

Life transitions

Boundary setting

Parenting/family stress

Women's mental health

LGBTQIA+ affirming support

Discrimination/marginalization

Other (text field)

Who are you seeking therapy for?

What age group is the client?

Do you have any therapist preferences?

Do you plan to use insurance?

How would you like us to follow up?

Email me

Text me

Call me

By checking this box, I consent to receive communication from Mindful Healing Counseling related to my therapy services. This may include appointment reminders, scheduling updates, and important practice notifications. Message frequency may vary. Message and data rates may apply. You can reply HELP for assistance or STOP to opt out at any time.