WISDOM WITHIN YOU THERAPY
About Kali
Holistic Therapy
Client Booking Form
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Holistic Therapy
Consult and Booking Form.
Please note I only accept Private Pay Clients ($120/50 minute session) BCBSVT, Medicaid or
Sliding Scale
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Name
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Why are you seeking therapy at the moment? What are your goals? What is your payment method?
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Are you on any medication, if so for what? Do you have a history or current thoughts of self harm, suicide or harm to others?
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Have you seen a therapist before? If so, explain.
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About Kali
Holistic Therapy
Client Booking Form
Contact