Private Consultation Request
Farshid works with a limited number of clients at a time. This short form allows him to understand your needs and determine whether the focus of the practice is the right fit for your goals. All submissions are reviewed personally. If aligned, you will be contacted to schedule a brief phone or video consultation.
Name
Last Name
Age
Email
Phone
Preferred Method of Contact
Email
Phone
Text Message
No preference
Where do you currently reside?
What are you hoping to explore or address in therapy at this time?
Are there specific relationships you'd like to focus on?
Have you previously participated in psychotherapy or counseling?
Yes
No
Prefer not to say
Are there any scheduling preferences or constraints you’d like me to know about?
Is there anything else you’d like to share at this stage?
How would you describe your level of readiness for self-reflection and personal change?
I feel ready to explore things more deeply
I'm not sure yet, but I’m open
I'm mainly looking for advice or solutions
How did you hear about Farshid’s practice?
Is there anything else you’d like to share at this stage?
Privacy Note
Your information is kept strictly confidential and will not be shared.
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