Please take a minute to tell me about yourself and your wellness goals. To Vitality and Beyond * Tell me about yourself First Name Last Name Date of birth * Inclusivity * How do you identify? Phone * (###) ### #### Email * Goals * Tell me a little bit about what your health goals are or what what you would like to work on. General Holistic Wellness Holistic Burnout Recovery Improve Self Care 1:1 Wellness & Herbal Coaching Herbal Self Care Products Herbal Wellness Workshops Connection with Self, Community and nature Wellness Advocacy Support * Tell me a little bit about your support system and what health promoting activities you are already involved in. I have a mental health and primary care providers I need help finding a mental health or primary care provider Thank you! Please schedule a 30 minute exploratory call with me, if you haven’t already done so. If you are in need of immediate mental health or medical support please call Multnomah County mobile crisis services line 503-988-4888 - or text "OREGON" to 741741 (this line is available 24/7)
