This will allow me to know more about your unique situation and guide us to the best services.
Do you agree to have me contact you through text messages? Ie. confirm appointments?
Brief summary of why you are looking into counseling:
Tell me a little bit about your situation and what brings you here:
Have you had any prior counseling or experience with holistic medicine or treatment? Briefly describe
What are your top three counseling goals?
Are you interested in wellness coaching or natural solutions for better brain chemistry?
Are you interested in quantum biofeedback services or learning more about quantum medicine?
Are you interested in the benefits of working with my co-counselor Tami Poteet?
Are you interested in Ideal Life Vision classes or retreats to amplify your results?
What is your payment source (Insurance Company, EAP Provider, Third Party Billing or Out of Pocket? Also, what is your monthly wellness budget for copays, supplements, sessions, etc.? This will allow me to consider economical or upgrade options for your treatment.
Are you able to pay out-of-pocket if you insurance doesn't cover?
You will receive a confirmation email with the next steps based on your answers above. Contact me by email if needed: firstname.lastname@example.org
Do you have any questions for me? Is there anything else I should know to best support you?
Do Not Fill This Out