Shiloh Wellness

I am looking for support for?

DOB

Date of birth

Gender

Have you worked with a therapist or wellness provider before?

What led you to seek support at this point in your life?

What qualities are most important to you in a provider?

eg, Modality Style, General Style, Cultural Background

Relationship Status

Are there any relationships or life transitions you'd like support with?

Optional

Do you have a preference for your provider's gender?

What times generally work best for you?

This is a general question, and can always be coordinated.

What are you hoping to gain from your experience with a provider?

I understand that the information shared is used solely for the purpose of matching me with a provider and coordinating care. *

Which days usually work for you? *

We use this to find providers whose schedule actually lines up with yours.

What time of day is best? *

Early birdMornings, 8:00am – 12:00pmDaytime9:00am – 5:00pmLunchtime12:00pm – 1:00pmAfternoon1:00pm – 5:00pmAfter work5:00pm – 7:00pmEvening6:00pm – 8:00pmNight owl8:00pm – 12:00amTotally flexibleAny time generally works for meSomething unusual?Odd hours — tell us more and we'll work it out

Full Intake