Self Care Coaching

    General Info
    We put privacy first. Any information provided by you is used to understand your needs and provide a better service. We may use your information for the following: to fulfill your requests in a timely and effective manner, to improve our products or services based on your needs, or to personalize your experience according to your interests. ATMH will not sell, share, or distribute your personal information to third parties.

    First

    Last

    City

    State/Province

    Email

    Phone

    Birth date

    Referred by

    How did you hear about us?

    Demographics
    We ask the following information because we would like to get to know you better. Your info is confidential and privacy is important. Any information provided by you is used to understand your needs and provide a better service.

    Gender

    Age

    Race/Ethnicity

    Preferred Language

    Relationship Status

    Identify as

    Self Care Coaching
    Please select your self care areas of interest. You may select multiple areas of interest.
    Areas of interest
    Helping new freshmen on campusHelp dealing with text anxietyHelp building social relationshipsHelp adjusting to social issuesHelp dealing with stress

    Additional Info
    Please provide us with any additional information you think we should know. Also, we are always open to feedback and suggestions so feel free to speak your mind. We’re here to answer any of your questions or concerns.

    WHAT'S NEXT?
    After submitting this form, you may use the Positivity+ app to schedule your session. Please click the Send button below.
    This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.