Name *

First Name

Last Name

What would you like help with? (Please select all that apply):

Anxiety

Death anxiety

Obsessive-Compulsive Disorder (OCD)

Health anxiety

General anxiety

Social anxiety

Phobias (e.g. fear of needles, heights, flying)

Panic attacks or panic disorder

Post-Traumatic Stress Disorder (PTSD)

Stress

Other

Other areas

Depression

Bipolar Disorder

Addiction or substance use

Attention Deficit Hyperactivity Disorder (ADHD)

Autism Spectrum Disorder (ASD)

Personality disorder

Chronic pain or illness

Relationship concerns

Gender dysphoria

Eating disorder

Other