Intake form

Name *

Email address *

What themes resonate with you?

Please select at least one option.

Addiction

Trauma

Healing

Self-discovery

Resilience

Mental Health

How did you hear about MelsJourne?

What type of content are you interested in?

Please select at least one option.

Poetry

Prose

Workshops

Personal Coaching

Community Events

What challenges are you currently facing?

What are your goals for engaging with MelsJourne?

Are you open to sharing your story?

Would you like to participate in any upcoming events?

Additional questions or comments

Mels Journe - Walking the Path to Finding her " Y"