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Consultation Questionnaire
Hello and welcome! I would love to know more about you! Please fill out this questionnaire at the best of your ability so that we can schedule your consultation. I look forward to connecting!!
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Email
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Your email
Please share your name and what brings you here :)
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Your answer
Outline any experience you have with any supportive therapies such as counseling, coaching, or energy healing...
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Your answer
Have you been diagnosed with any mental health issues in the last 5 years? If so, please tell me about it.
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Your answer
Are you looking for...
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Somatic Counseling
Breathwork + Energy Work
Groupwork
Intuition Training
Not sure
If you could wave a magic wand, what would you like to change about your life?
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Your answer
What are three of your biggest struggles?
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Your answer
What are you on your Hero's Journey?
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This is my first stop on my healing journey.
I am curious and willing to begin.
I have been to therapy before, so I am aware of my emotions.
I have a relationship with my emotions and feel them in my body.
I got the call to awaken more of who I am or step into something different.
I have had several awakenings in my life and ready for the next layer.
I am aware of my energy body.
I have had mystical experiences.
Other:
Anything else that feels important for me to know?
Your answer
Wonderful! I will reach out to set up a time for us to connect. What time of the day works best for you?
Morning
Afternoon
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Other:
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