Request a Session

Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Areas of need/ Symptoms

Please check all that apply

Increase in sadness/ depression

Increased anxiety/ worry

Trauma Response

Panic Attacks

Emotional Dysregulation

Trouble concentrating

Difficulty Sleeping

Low motivation

Tearfulness

Fear

Hopelessness

Low Self Esteem

Fatigue/ low energy

Isolation/ withdrawal from others

change in appetite