Relationship Consulting Intake form
If you are interested in Dr. Zhana's Relationship Consulting, please complete this short intake form.

Please note: I am NOT a therapist. I don't diagnose or treat mental health conditions, sexual dysfunctions, or deeply rooted unhealthy relationship patterns. I am a relationships consultant specializing in relatively short-term (though often intensive) interventions aimed at guiding individuals, couples, and larger relational units in making smart decisions about the type of sex and love life they choose to design and how to implement those choices well. Often, the work we do together will be most effective if you (and your partner/s) have an individual and/or couples therapist I can coordinate with.
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Email *
What's your name (or the name you'd like me to use for you)?
How did you find me?
Tell me a little about yourself and why you’re currently seeking my assistance. (Provide as much info as you think is relevant.)
What have you done so far to try and address this issue / issues?
Anything else you'd like me to know about you or your life circumstances?
Ready to take the next step? Schedule a FREE 30-min consultation to determine if we're the right fit for each other!
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