GEAUX BEYONDW E L L N E S S

PERSONAL INQUIRY / GEAUX BEYOND WELLNESS

A thoughtful
first conversation.

Share what you would like to discuss, ask your questions and take the time you need.

Completing an intake does not book a session, establish eligibility or constitute informed consent to participate. There is no obligation to proceed.

Read preparation and participation information ↓

YOUR INTAKE

Your voice.
Your choice.

Your intake information

01 / ABOUT YOU

How can Justin reach you?

To be confirmed privately before any participation.

Preferred way to discuss next steps

02 / YOUR INTEREST

What would you like to explore?

Which arrangement would you like to ask about?

These are inquiry preferences, not recommendations or a prescribed course of sessions. Availability and suitability require a separate discussion.

03 / INFORMATION FOR DISCUSSION

Discuss health and practical considerations.

The topics below help organize a private discussion. They are not a complete contraindication list, a diagnostic assessment or an automated eligibility decision. You may choose to discuss sensitive details privately.

How would you prefer to discuss personal health information?

Do not discontinue or change any medicine based on an intake form.

Please raise questions with your licensed clinician and Justin before making arrangements.

Topics you would like to discuss privately (select any that apply)

04 / NEXT STEPS

An inquiry, not permission to proceed.

Any proposed participation requires its own discussion of risks, relevant health information, alternatives, the option not to participate and informed consent. No appointment, eligibility decision or participation agreement is created by this intake.

No liability release or waiver of legal rights is included in this review form. Any separate participation agreement must be provided for review before participation.

No marketing consent is bundled with this inquiry. You can choose to discuss sensitive details privately instead of entering them here.

Call Justin · 228.596.3521

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