Interest Form Name * First Name Last Name Email * Phone (###) ### #### Preferred Contact Method (Check one) Email Phone Calll What Services Are You Interested in? (Check all that apply) Coaching Services EMDR Therapy Speciallized Assessment & Plan Not Sure - Help Me Decide What's motivating you to seek support? * Have you worked with a Coach or Therapist before? Yes No Self-Help books/podcast Are You Lookinig for Telehealth Or In-Person Services? (Select one) Telehealth (Available in AZ and select states) In-Person ( Currently unavailable w/ possible refferal sources available) * I confirm that the information I have provided is accurate to the best of my knowledge. I understand that by clicking "Step One: COMPLETE," I am submitting my interest, and a team member will reach out within 24-48 hours to discuss my needs and goals. You're all set! 🎉 Step one is complete. Our team will reach out within 24-48 hours to connect and guide you on your journey. Talk soon!