Thank you for booking a session! I look forward to working with you. Please provide your contact information and any other information you’d like to share about your life journey - past, present & future. Name * First Name Last Name Email * You will be added to my mailing list to receive occasional updates and free resources. Your information is never shared and you can unsubscribe at any time. Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country What type of sessions do you prefer? * In-person Online I am flexible Tell me a little bit about yourself, whatever you'd like to share. What are your desires and intentions for our work together? What are you currently struggling with in your life? What is currently going well in your life? Do you have any trauma in your history? If so, please tell me a little bit about it - only if you are comfortable doing so. Trauma can stem from physical abuse/assault, sexual abuse/assault, emotional abuse, birth complications, intergenerational trauma, medical procedures, injury, motor vehicle accidents, near-death experiences, systemic oppression, loss of loved ones, and other experiences. Symptoms can include: chronic stress, habitual and harmful use of substances, repressed emotions, depression, phobias, difficulty in relationship, social anxiety, perfectionism, boredom, physical ailments, and/or disease. Are you currently experiencing any of the following: chronic pain, chronic anxiety, depression, chronic stress, chronic disease and/or chronic tension in parts of your body? If so, please tell me a little bit about it. How do you cope with stress? On a scale of 0-5 (zero = never, 5 = every day or almost every day), how often do you feel the following emotions: Anger 0 1 2 3 4 5 Sadness 0 1 2 3 4 5 Joy 0 1 2 3 4 5 What feelings and experiences would you like to have more of in your day-to-day life? Have you done healing work/therapy in the past? If so, please tell me a little bit about your experience. Are you currently taking any prescription medications that affect your mental health? If so, please list the medication name(s) and reason for use. Are you currently working with any healers/therapists? If so, what type of work are you doing with them? Is there anything else you would like to tell me? How did you find out about me? Thank you!