Contact

Contact Information

For general inquiries, please email connect@kionaedwardstherapy.com

For Therapy Groups, register here.

For Workshops, register here.

For virtual individual therapy/ life coaching services, fill out the form below.

Individual Therapy Intake Form

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health to there

Name *

First

Last

Email Address *

Phone Number *

Age *

What state do you reside in? *

Please note: Im licensed in NY, and can only see people residing in New York State for therapy.

Tell me what you want to explore in therapy, including anything you want to address, or goals you have. *

Please be as detailed as you can!

Have you been in therapy before? If so, please share about your experience. Specifically, what was helpful for you, or what didnt resonate or integrate for you. As well as any mental health diagnosis you may have received. *

When are you generally available for sessions? *

Is there anything else that feels important to share with me? Any questions you'd like to address in a potential phone consult? *

Acknowledgement *

• I have read and understand the above information

Submit