Holistic Trauma Healing 1:1 Program Application

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Please be as detailed as possible. Tell me WHY you want to work with me. Your information is 100% confidential.

Email *

Name *

Cell Phone # *

Age *

Instagram Handle

Please tell me about your trauma and what you've done to work through it so far. *

Tell me about your spiritual beliefs. What do you believe happens when we die? Are you religious? What do you believe is the purpose of life? *

What are your top 3 goals for your life? *

What have you done so far to make progress on those goals? *

What do you think is holding you back? *

Please briefly describe your understanding of trauma's effects on the nervous system. *

What healing modalities do you have experience with? (Check all that apply.) *

meditation

breathwork

cognitive behavioral therapy (CBT)

EMDR therapy

Reiki, sound bathing, chakra balacing, & other energy healing

somatic processing

talk therapy

psychiatric medications

cold plunges

supplements & healing diets

neurolinguistic programming (NLP)

hypnotherapy

Emotional Freedom Technique (EFT - tapping)

psychedelics (such as magic mushrooms, LSD, MDMA)

bodywork ( such as myofascial release, pelvic floor physical therapy, & massage)

embodiment and dance/movement

journaling

marijuana or CBD

herbal medicine (tinctures, teas, etc.)

homeopathy

past life regression

Other:

Required

Of the healing modalities listed below, please check the ones you are NOT willing to try. (Check all that apply.) *

meditation

breathwork

cognitive behavioral therapy (CBT)

EMDR therapy

Reiki, sound bathing, chakra balacing, & other energy healing

somatic processing

talk therapy

psychiatric medications

cold plunges

supplements & healing diets

neurolinguistic programming (NLP)

hypnotherapy

Emotional Freedom Technique (EFT - tapping)

psychedelics (such as magic mushrooms, LSD, MDMA)

bodywork ( such as myofascial release, pelvic floor physical therapy, & massage)

embodiment and dance/movement

journaling

marijuana or CBD

herbal medicine (tinctures, teas, etc.)

homeopathy

past life regression

Other:

Required

If you would describe any point in your journey as an "awakening", please tell me what that was/is like for you.

Please list your TOP 5 daily stressors: *

The 12-week Holistic Trauma Healing Program requires an investment of time, energy, and vulnerability. While it is very helpful and preferred for you to have a support system or person in place, this is YOUR work. If you do not have or cannot find several extra hours each week during the 12 weeks due to your job, children at home, your partner, extracurricular activities and commitments, it is important to be honest with yourself and with me about this. A lot has to go into this program from both sides, yours and mine, in order for it to be beneficial for you. With that said, how willing and able are you to find or create several extra hours per week for 12 weeks? *

I DO NOT have several extra hours per week to commit to this program.

It is difficult for me to find extra time for myself, but I will do my best.

I know there are some things I can move around or un-commit to in order to do this, and I'm willing to do what it takes.

I can't afford NOT to find the time and energy for this program! I'm READY!

Fill in the blank: "I will feel our work together was completely worth it if ________________________" *

If you knew that you could accomplish at least one of your goals above during this 12-week coaching program, what would you be willing to invest? *

$0 to $500

$500 to $1,200

$1,300 to $2,500

$2,500+

Other:

How open are you to receiving honest and candid feedback about your life, choices, patterns, and behaviors? *

I'm NOT AT ALL open.

I'm SOMEWHAT open.

I'm CURIOUS.

I'm VERY open.

I'm COMPLETELY open.

Other:

If you selected SOMEWHAT, CURIOUS, or VERY open above, choose 1 or 2 statements below that most accurately describe you. *

Sometimes feedback feels like criticism, however I am aware of this and I'm trying to grow.

Just give it to me straight but respectfully; don't sugar-coat it. I can take it!

I get triggered if anyone tells me I need to change. No thank you. Let me figure it out myself.

I get overwhelmed if there's too much feedback. Give it to me slowly and gently.

Rip off the band-aid!I'm a self-improvement, spiritual growth junkie! Don't hold back!

I am open to honest, respectful feedback. I trust myself to know if it's for my highest good.

Other:

Required

There are thousands of online coaches. Why do you want to work with Lindsey 1:1? *

Is there anything else you want Lindsey to know?

Lindsey is NOT a licensed therapist, psychologist, or psychiatrist. She is a trauma educator and coach. This 1:1 coaching program is not intended to take the place of medical care provided by the practitioner of your choice. This program is also not intended to diagnose or treat any physical or mental illness or take the place of therapy provided by a credentialed therapist. Do you understand this, and do you consent to going through this 1:1 program with Lindsey? *

Yes

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