Please know all personal information is guarded by patient/wellness provider confidentiality. Name * First Name Last Name Email Phone * Please provide a landline or mobile # where I can reach you. (###) ### #### Present Well-Being * Are you or anyone in your family presently in emotional or physical danger? Current Challenges * In a few words, can you let me know what current challenges you're facing? Emotional Care Are you currently engaged in any counseling or therapeutic relationship? Seeing a Life Coach Family Therapy Individual Therapy Thank you for reaching out. Give me 24 hours and I’ll reply so we can get started - and find new ways for you and your family to be well, together. Stephanie
