Intake form

Name *

Email address *

What brings you to kind connection today?

What topics would you like to discuss?

Please select at least one option.

Mental Health

Relationships

Career

Grief and Loss

Stress Management

Personal Growth

Life Transitions

How did you hear about us?

What is your preferred method of communication?

Please select at least one option.

Text

Email

Phone Call

Video Call

Please share any specific concerns or experiences you would like to address.

Which service or services are you interested in?

Please select at least one option.

<p>One on One listening session</p>

Support circles

Empathy exchange

Additional questions or comments

Kind Connection