New Client Intake Form
This program is for stressed out, overwhelmed women, who want to feel safe and connect to their body so that they can overcome shame, perfectionism & procrastination.
 It's my intention that our time together will provide you tools to heal and connect - with yourself, with others, and with what make you come alive!

Together we’ll strategize and intuit a holistic healing path of science and spirit using a unique blend of modern somatic experiencing, ancient yogic philosophy, and integrative health coaching. - It’s grounded in science, with a healthy amount of ‘woo.’

Please fill out the following as openly and honestly so we can make sure this program serves you best.

Thank you!

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Email *
Phone Number *
Name *
Preferred Pronouns
Age *
Where do you currently live / Time zone? *
Have you done therapy, coaching, or any other personalized healing modality before? *
Please share 2-3 areas or aspects of your life that feel challenging, stressful, or are distracting you from your joy: *
How are these challenges impacting your daily life? *
Do you experience any disruptive, distracting, or uncomfortable physical sensations? If so, please share where.
In your ideal scenario, how would you rather feel? (What would your life look like if you resolved these challenges?) *
How motivated are you to this transformation? *
Defeated and skeptical
Motivated and ready
What's at stake if you don't take action now?
Anything else you'd like me to know?
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