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Session with Nira Inquiry Form
Hi there - please fill out this form to sign-up for the practicum session. I will review your application to see if we are a good fit for working together and get back to you within 24-48 business hours.
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Email
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Your email
First Name
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Your answer
Last Name
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Your answer
Email address:
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Your answer
Phone number:
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Your answer
What would you most like to gain out of our work together?
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Your answer
Are you willing to commit to a minimum of 5-10 sessions?
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Yes
No
My work is focused on emotions and energetics/spiritual side of things. Is that something you are interested in?
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Yes
No
Have you worked with a therapist or Life Coach in the past?
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Yes
No
If you answered yes to the above, please briefly describe your experience.
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Your answer
Are you over the ager of 18?
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Yes
No
Sessions will be virtual.
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Yes, I understand this.
No, I am not interested in virtual sessions.
Is there anything else you would like to share or questions that you have?
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Your answer
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