Please answer the following questions in order for me to learn more about you, your experience with Clinical Providers, your Growth Potential needs/wants, and how Clinical Consultation could benefit you.

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* 1. In general, how would you rate your overall Mental Emotional Health & Wellbeing?

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* 2. What area of your life are you most interested in pursuing & cultivating your Growth Potential?

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* 3. Have you ever sought formal Mental Health Counseling before?

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* 4. Have you ever been hospitalized and/or on Medication for a mental health issue, such as Depression, Anxiety, Suicidal Ideation, Self Injurious behaviors, Homicidal Ideations, Post Partum Rage?

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* 5. If you've ever engaged in formal Mental Health treatment, what wasn't helpful? What did you wish was different?

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* 6. If you could have access to personalized, convenient Professional Coaching/Clinical Guidance what area would you be most interested in (Choose your top 2)?

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* 7. What are your best days or times of contact for consultation and/or sessions?

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* 8. Are you feeling motivated to cultivate a strategic plan for your Self Growth?

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* 9. How do you prefer feedback or suggestions?

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* 10. If you wish to schedule a Free Consultation, please follow the link on my Facebook Page or Website to book.

https://www.facebook.com/kellybakothesource

https://www.kellyyounkinsclinicalconsultant.com/contact.html

If you have already completed a Consultation, please complete the Client Demographic Form and Service Agreement that will be sent to you via link via text or email.

Thank you!

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