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Pine-Tree Wellness Talking Therapy
Jess Pinheiro
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Birthday
*
Day
Month
Year
First name
*
Last name
*
Phone
Email
*
Address
*
Could you offer a brief explanation of your concerns, challenges, or goals would you like support with?
*
What areas you feel you would benefit from support considering your current struggles?
Anxiety
Low Mood
Emotions
Sleep
Motivation
Worry
Eating dificulties (Binge-eating)
Confidence
Boundaries
Other
Prefered method of contact for 15 minute free consultation
*
Telephone call
Text message
Email
Is there anything that would help make our sessions more comfortable, accessible, or supportive for you?
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