RSVP 4 — Mindful Life Therapy LLC

Client contact form

Welcome! Thank you for expressing interest in working with the Mindful Life Therapy team. We look forward to connecting with you. Please complete the following basic information.

Courtney Battista (Mindful Life Therapy Psychotherapist/Owner) will reach out to complete the screening process

Name

First Name

Last Name

Phone

(###)

###

####

Please provide a brief summary of what brings you to therapy

Please describe your previous therapeutic experiences. What worked well, what didn't?

Are you looking for in person or telehealth at this time?

In Person Only

Telehealth Only

Open to Either/First Available

Do you have any current/past suicidal ideation? (PESS for emergency psychiatric support-(908) 526-4100)

Yes

A referral is the biggest compliment, who referred you to Mindful Life Therapy?