journey prep form

The answers you offer will be used in our first coaching session to prepare your mindset for your upcoming journey. Please answer as thoroughly as you can but there is no need to repeat yourself. If you feel you’ve already provided a sufficient answer in a previous question, you can skip it or write, “already explained”. If there is sensitive material you’d rather cover in person, you can also skip it or write, “will discuss in person”. Thank you for your honesty and clarity.

Name *
Name
Address
Address
Name of Emergency Contact *
Name of Emergency Contact
Phone Number of Emergency Contact *
Phone Number of Emergency Contact
For the following questions, please take your time and give as much detail as you can
Have you ever been diagnosed with mental illness?