Evaluation

Request for Help

First Name

Last Name

Phone/Mobile

Municipality

Address

State

Country

What is your goal in contacting us?

What kind of behaviours or attractions do you want to reduce?

Do you understand that we are not claiming to be professional counselors but simply have personal experience struggling with these issues as well?

How do you identify currently?

Would you prefer to meet with a biological male or female volunteer (though we will try to meet this request, we cannot guarantee it)?

What times are best for you to meet on-line?

When are you available for your first assessment meeting?

Do you have any other questions?