Danielle Jones-Dent | SimplePractice

Who would be receiving care?

Someone else

Your info

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Reason for care

Which service are you interested in?

(Required, single-select / checkbox if multiple options are allowed)

Individual Therapy (mental health, stress, relationships, life transitions) Therapy for Athletes (anxiety, burnout, injury, sport transitions) Mental Skills & Performance Coaching (focus, confidence, resilience, mindset) Leadership or Professional Coaching (communication, emotional intelligence, workplace support) Sport Coach Consultation (team culture, communication, athlete well-being) Sport Parent Coaching & Consultation (sport stress, expectations, home support) Group, Team, or Organizational Workshops (resilience, leadership, performance topics) Not sure yet (we’ll determine during your consultation)

Administrative

How did you hear about Danielle Jones-Dent or Guided by Grit?

Sharing how you found me is optional, but it’s helpful for me to know.

Acknowledgment of Services

Submitting this form does not establish a therapeutic relationship. Services, eligibility, and fees will be reviewed during your consultation.

I understand and acknowledge this information

Billing & Payment

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Client Preferences

Preferred appointment times

Morning (8am–12pm) Afternoon (12pm–5pm) Evening (5pm–8pm) Flexible

Preferred modality

Anything you’d like your practitioner to know before your consultation?

e.g., accessibility needs, focus areas, or anything we should know before your consultation

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

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.