What is your primary concern?
Emotional drain Unhealthy patterns Past traumas
How often do you feel overwhelmed?
Daily Weekly Occasionally
Are you seeking long-term change?
Yes No Not sure
Have you tried therapy before?
Yes No Considering it
How do you prefer to address stress?
Meditation Talking it out Exercise
What support do you value most?
Professional help Peer support Self-help resources
All set, how can we reach you?
Name
Email
Phone
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