Mindfulness Therapy Consultation Form

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At Divine Healing LLC, we want to ensure that your needs are targeted and met during your Mindfulness Therapy session. Our services are client-centered, to meet you where you're at and better serve you.

Our mindfulness sessions are designed to help you build your mindfulness practice, target and deplete different stressors (e.g., anxiety, stress, depression), and focus on positive factors through a S.M.A.R.T goals and Strength-Based approach. To identify your goals and contributive details before your consultation, please fill out the following form.

Email *

Full Name (LN, FN) *

Appointment Type *

Are you familiar with or have practiced Mindfulness? *

Yes

Somewhat

Choice of Target *

Enhance Mindfulness Practice (Education and Practice methods)

Target specific Mental Health condition (e.g., depression)

Target stressors (e.g., release anxiety or stress)

Inner healing (e.g., instill positive affirmations)

Deep breathing calming techniques

Identify and target current emotions and feelings

Other:

Required

If you selected other or would like to elaborate more, please write your response below.

What is your stress level on a scale of 1-10? (10 being the highest stress level) *

What are your overall goals? *

How did you hear about us? *

Send me a copy of my responses.

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