Application Page

STEP 1 OF 4

1. Submit Application> 2. Application Review> 3. Discovery Call ($)> 4. Book Your Therapy Season

1. Application > 2. Review > 3. 1-on-1 Call > 4. Book

APPLY TO GET STARTED

*Complete to the best of your ability. Please note this application does not save. Copy and paste answers as a backup method.

First Name *

Last Name *

Email Address *

Phone Number *

How did you hear about me? *

[ Locations ]

Home City *

Home State/County/Province *

Home Country *

Current Location *

Current Timezone *

[ About You ]

Country of Origin

Relationship Status

Are you a parent?

Are you a mental health professional? *

Yes

Profession *

Are you a business owner?

Yes

What is your business?

Are you an expat, digital nomad or remote professional? (Select all that apply) *

Yes, *Expat–I live and work abroad.

Yes, Digital Nomad, Home Country–I frequently travel, to multiple locations, but mainly in my home location/country.

Yes, *Digital Nomad, Abroad–I frequently travel, to multiple locations, internationally.

Yes, Remote Professional, I do NOT travel frequently, but work from home, in my home country.

Yes, *Remote Professional, Abroad–I do NOT frequently travel, but work from home in another country.

No, none of the above

[ Therapy ]

Are you planning to use your insurance? *

Yes, I have insurance, and, would like to use.

No, I do not have, or, am not planning to use insurance.

Does not matter, or, whichever is ideal.

Unsure.

Have you ever been in therapy? [Type] *

Have you ever been in therapy? [Time] *

What therapy are you interested in primarily? *

What brings you to inquire about therapy? Why now? *

[Final Thoughts]

How will you know your time in therapy has been successful?

Any additional information you'd like to share with me?

Captcha