Get in touch. Name * First Name Last Name Email * Phone * How did you hear about Jiva Wellness? * What are your top 2-3 personal development goals? Bare in mind, this website is not a secure or HIPAA-covered portal. Do you have specific scheduling needs? What will your regular availability for meetings look like? Anything else I should know? What drew you to my work? Bare in mind, this website is not a secure or HIPAA-covered portal. Please check this box to acknowledge that you understand that we at Jiva Wellness can only support clients who's needs fit within the expertise and level of care of our practice. If we are not the right fit for you and feel you need a different type of support, we will recommend other potential supports for you as best we can! * Thank you!