Liana Kares Chat Intake Form (BETA)
Thank you for your interest in the Liana Kares online personal coaching service.  Liana Kares is currently in beta, and this method of booking is temporary.  I greatly appreciate you being an early supporter of this service.  

I'm available to chat Wednesdays and Thursdays. Each one-hour session is $40 USD. If you absolutely cannot be available on these days, limited alternative times are available at the rate of $80 USD per hour.

Payments are accepted via Paypal.  Chats are available via video conference on Zoom, voice only chats via Zoom or Discord, or live text chats via Discord or Telegram.

Note: Liana Kares is not a crisis service, nor is it professional counselling. If you are in crisis, please consult https://suicidepreventionlifeline.org/ in the US, https://www.crisisservicescanada.ca/en/ in Canada, or https://www.opencounseling.com/suicide-hotlines internationally

Please fill out this form and I'll get back to you with times, payment instructions and how we'll connect!  Expect a response within 2 business days!
Email *
Please confirm your email address (make sure the spelling is correct!) *
Please review the consent form PDF found here: https://tinyurl.com/3j6yafty Do you agree to the terms of the waiver? *
Your name (your real name is required for the consent form confirmation) *
Today's date (For the purposes of the consent form)
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What name do you prefer to be called? *
If you live in Canada, please indicate the province you live in (this is for tax purposes) (If you do not live in Canada skip to the next question.)
If you do not live in Canada please indicate your country of residence and the time zone you are in.
Your preferred pronouns *
How do you prefer to communicate? There are no wrong answers here. It's all about your comfort. *
Liana Kares is currently chatting Wednesday and Thursday days and evenings, Eastern Time Zone. What times are good for you? (check all that apply) *
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What sort of support are you looking for?
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What would you like to talk about? Provide as much or as little detail as you like. Any specifics you provide will give you more time for discussion, because I already know the basics, but it's okay to not quite know where to begin too!
If you have previously received therapy from a licensed counsellor, psychologist, psychiatrist or social worker, etc, what did you find positive and negative about the experience?
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