Value Yourself Counseling LLC Feedback Form
Thank you for taking the time to answer the following questions. This information will be kept protected and is to help me know how to continue to best meet the needs of potential clients. You will be added to my email list yet may unsubscribe at anytime. 
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Do you identify as a woman, trans woman, non binary or gender expansive (basically non male)?
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What is your age range?
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What are your biggest challenges, pains, struggles and/or obstacles right now (particularly in regard to emotional health, personal growth, self-care, and/or your relationship with yourself)? *
What would you like to change most for your emotional wellness, personal growth, and/or relationship with yourself within the next 3-6 months? *
What gets in the way or holds you back from making changes? Or from getting support to change? *
How would you prefer to feel about your life/emotional well-being/yourself? *
How would your life be different if you were able to get support to help you feel how you desire? *
Thank You!
Sharing your answers to these questions will help me best serve more people in the way they need. I appreciate your time and energy so much! Thank you! Take good care of yourself!
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