JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Intake Form
This is me getting to know you :)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name:
Your answer
preferred pronouns?
Your answer
What do you consider the biggest problems/struggles in your life currently?
*
Your answer
Of what you listed above what feels like the largest priority to address right now?
*
Your answer
Do you have any specific goals you'd like to create or strive towards in our time together?
*
Your answer
How would you like to feel about yourself when this is over?
*
Your answer
Why do you want to work with me specifically?
*
Your answer
I ONLY work with clients who are ready & willing to do the work even (and especially) when it feels challenging and/or uncomfortable. Are you fully committed?
*
HELL YES!
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
