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Revitalize Wellness Counseling

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What symptoms or life circumstance are bringing you here?

Anxiety ADHD/ Neurodivergence Depression Trauma Religious Trauma/ Spiritual Abuse Decunstructing Religion/ Faith Body Image Relationship Issues Stress/ Burnout OCD Other

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

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Please verify that you scheduled your appointment for your correct time zone.

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

Revitalize Wellness Counseling

760.313.3731 |

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.