We cannot wait to meet you. Tell us about yourself. Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Age Gender identity * How do you identify? Female Male Nonbinary Trans woman Trans man Trans nonbinary Genderqueer Pronouns * Share your pronouns so we can be sure to honor that part of your identity. she series he series they series combination I don't understand what this means Racial/ethnic identity * Other key identifiers What other identities do you hold that you want to share with us up front? Do you speak English fluently? * Yes No No, but I am very conversant If you were to choose a small, affinity group to be part of, what identity marker would you choose? * For example: BIPOC, LGBTQ+, single parent, survivor of abuse, widow, etc. Have you engaged in therapy before? If so, for how long? * If you've experienced therapy before, what was helpful about it? What was not helpful? How did you hear about this community? * Michael's TEDx Friend Podcast Web search Advertisement on social media Michael's social media Other Thank you!
