Thank you for joining Anxiety to Zen!

I’m so glad you're here! I'd love to get to know you a bit before we start our work together!

Please complete the questionnaire below to introduce yourself, identify your goals, and specify whether you'd like to participate in an Accountability Pod.

Name

First Name

Last Name

Age

Phone

(###)

###

####

Email

Tell me a little bit about yourself.

Why are you interested in participating in Anxiety to Zen at this time?

What would you like Anxiety to Zen to help you accomplish?

How did you find Anxiety to Zen?

Are you interested in being matched with other participants into an Accountability Pod?

If so, what time zone are you in?

And, when is the best time for you to connect with other members of your Pod?

Check all that apply:

weekday mornings

weekday afternoons

weekday evenings

weekend mornings

weekend afternoons

weekend evenings

Is there anything else you would like Dr. King to know?

As indicated, this program cannot be appropriate for everyone, and may even be counterproductive for those experiencing severe mental health difficulties. If Dr. King has a concern, based on the information you've provided, that this program may not be a good fit for you, she will reach out to you to discuss.

Thank you for joining Anxiety to Zen!

Julia A. King, Psy.D., MBA, RYT 200Clinical Psychologist and Registered Yoga Teacher

Julia A. King, Psy.D., MBA, RYT 200
Clinical Psychologist and Registered Yoga Teacher