MindTribe

First Name

Last Name

Your Email Address

Which areas feel most difficult for you right now?*

How long have you been dealing with what’s bothering you?*

How much is this affecting your daily life right now?

Manageable Very overwhelming

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Have you taken counseling or therapy before?

Anything you’d like us to know about that experience? (optional)

Counseling at MindTribe is a paid professional service. Are you comfortable proceeding with paid sessions? *

What made you reach out for counseling now? Please share at least a few sentences (around 80 characters).

Counseling