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Leo Mind Personal Member Intake Form

Personal Information:

Date of Birth
Month
Day
Year

Emotional Wellness Profile:

(These questions help LeoMind understand you better and personalize your experience. All answers are optional but recommended.)

Which emotions do you currently feel most often? (Check all that apply)
Have you ever worked with a therapist, counselor, or coach before?
Yes
No
Are you currently working with a mental health professional?
Yes
No

(If yes, LeoMind encourages you to continue with your care team and use LeoMind as emotional support, not a replacement.)

Would you like LeoMind to recommend licensed mental health providers if needed?
Yes
No

Consent and User Agreement:

Disclaimer Acknowledgment:

LeoMind provides emotional support, mindfulness tools, and emotional AI companionship, but it is not a substitute for professional medical, psychiatric, or psychological treatment. If you are experiencing a crisis, seek immediate professional help.

Privacy and Data Agreement:

LeoMind values your privacy. Your information will never be sold and will only be used to enhance your emotional wellness journey.

You can request to delete your information at any time.

Emergency Acknowledgment:

LeoMind is not an emergency service. In case of suicidal thoughts, harm to self or others, or emergency situations, call 911 or a crisis hotline immediately.

Terms of Service Agreement:

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