First Name *

Last Name *

Email *

How would you describe your current professional role or context? *

What specific challenges are you currently facing? *

Have you participated in therapy before? If yes, please briefly describe your experience. *

What are you hoping to achieve through working with Melina?

I understand that Melina's practice is private, application-based, and utilizes structured containers/packages.

Note: All information provided will be kept strictly confidential