Page 1 of 1

Reconnected Space

Maria Zakrzewska, M.Sc. Psychologist

Apply to Work With Me

Thank you for your interest in working together. Please answer a few short questions so I can understand how I may be able to support you.

Your Information

Preferred Contact Method

What are you interested in

Please tell me more

- what would you like support with right now

- where would you like to be in 3-12 months from now if our work was successful?

What have you already tried to resolve your challenge and why did you decide to apply to work with me?

How did you hear about me?

Friends

Instagram

Facebook

Other professionals

Other

Untitled checkboxes field

I confirm that all information provided is accurate and true. I understand that submitting this form does not establish a therapeutic relationship and does not guarantee acceptance as a client. I agree to be contacted regarding my enquiry. Your information will be used only to respond to your enquiry and will be treated confidentially. Full privacy policy on my website