Counselling & Coaching

Please enter your information into the Counselling Request Form below. When you are complete, click on the “Submit Counselling Request” button and Anjali will be in contact with you shortly to confirm the details about your session.

Tell Anjali About Yourself and Any Current Challenges You Are Facing

Please briefly describe yourself and any challenges you may need help with.


Your Personal Information

Please enter your personal information below.

Full Name (required)

Age (required)

Address (required)

City (required)

Postal Code/Zip (required)

Phone (required)

Your Email (required)

Gender (required)
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Apt#

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Additional Comments or Questions