Request appointment | Mindful Growth Collective

What is the reason for seeking care?

Anxiety ADHD Autism Depression Grief Relationship issues Substance use Trauma Life Transition / Adjustment Personal Growth Spirituality EMDR Therapy Intensive (private pay only) Therapist Seeking Clinical Consultation Other

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

Please explain circumstances for seeking services

Limited to 600 characters

We need to ask questions regarding your current safety and stability. By clicking yes you consent to answering these questions truthfully.

Yes

Are you currently experiencing thoughts of suicide or thoughts of harming yourself or others?

Yes No

Do you currently have any intent or plans to end your life?

Yes No

Have you had past suicide attempts or mental health-related hospitalizations?

Yes No

Are there any current behaviors that feel unsafe or out of control?

Yes No

Are you experiencing symptoms of psychosis (hallucinations, delusions, paranoia, etc.)?

Yes Not currently but in the past No

Please note that due to high demand, we are currently waitlist only for ongoing therapy. Are you interested in joining our waitlist?

Note: We have current openings for therapist clinical consultation and for EMDR intensives.

Yes, I would like to go forward with a consult to join your waitlist No, I am not interested in joining the waitlist and will stop filling out the prescreener N/A - I am looking for a private pay EMDR intensive N/A- I am a therapist wanting clinical consultation to elevate my skills as a therapist

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