JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
1-1 Session Inquiry - Anxiety Intensive
Please fill out the below information and I'll be in touch if we're a good fit to work together!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your name
*
Your answer
Your email
*
Your answer
How did you hear about me?
*
Instagram
TikTok
Youtube
I heard you on a podcast
I read one of your books
Internet Search
Other:
Tell me about what makes you anxious, overwhelmed, or worried.
*
Your answer
How long has anxiety been a part of your life?
*
Your answer
Do you know why, where, or when it started for you? If so, please share briefly.
*
Your answer
On average, how intense is your anxiety?
*
1 (least intense)
2
3
4
5
6
7
8
9
10 (most intense)
How much does your anxiety interfere with your life?
*
1 (extremely rarely)
2
3
4
5 (occasionally)
6
7
8
9
10 (on a daily basis)
Have you tried any other methods before to help with your anxiety? If so, what?
Your answer
Is there anything else I should be aware of? Do you have any questions or concerns?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
