Attachment Repair Meditation Guidance Client Intake Form
Please note that Attachment Repair (AR) Guided Meditation facilitation is supported by a healthy diet, regular physical exercise, good sleep hygiene, healthy social engagement, an established livelihood, spiritual practice/meditation, medical care, psycho-therapy, or psychiatric care.  AR facilitation is not a substitute for any of the aforementioned.

 -Regarding the form -  just fill out whatever is relevant.  No need to fill out the whole form if you don't want to.
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电子邮件地址 *
Name *
How did you find Attachment Repair.com? *
Which of these best describes you?  
Brief description of psychotherapy background.  How long did you go to therapy?  What type of therapy was it?  Why did you go?  What were the results of going to psychotherapy for you?
Which of the following describes you?
Brief description of meditation practice background.  Have you practiced meditation and if so, how long have you been practicing and how much?  In which traditions have you practiced, which practices?
In a sentence or two why are you interested in attachment repair?
This question and the one following it gives us a hint as to what your attachment style might be:  My general assumption is that others are trustworthy and want what is best for me.
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Another question that might give us a hint as to your attachment style.
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What do I need to know about you that will help me guide you best and help you feel comfortable and at ease?
Are you in a place where you are willing to practice the Attachment Repair meditation for 20 to 40 minutes, three to six days a week with the goal of moving your underlying attachment conditioning from insecurity to security?
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I charge $175 for a 50 minute session of Attachment Repair Meditation Guidance.  Are you financially in a place where this is possible for you on a weekly or fortnightly?  If not please fill out the form anyway and I'll make a referral to more affordable, and relevant options.  There is no charge for the initial, intro session.
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Knowing what your interests are in life is helpful in informing me as how to approach working with you.  Please list out four to eight areas of personal interest (hobbies, areas of investigation, etc)
What kind of work do you do?
What time zone are you in?
What days of the week and times of day generally work best for you? - Select all that apply.
For most people, doing psychotherapy makes for a great adjunct to guided attachment repair meditation.  It's not required.  But, Cedric strongly recommends it as a helpful adjunct. *
I understand that Cedric Reeves is a meditation instructor and not a therapist, psychotherapist, counselor, psychologist, or psychiatrist.  The Attachment Repair guidance offered is offered as guided visualization meditation.   *
I understand that any advice given is not intended to supplant or contravene the advice of my medical doctor, psychologist, psychiatrist, counselor or any other wellness professional. *
I understand that Attachment Repair (AR) Guided Meditation facilitation is supported by a healthy diet, regular physical exercise, good sleep hygiene, healthy social engagement, an established livelihood, spiritual practice/meditation, medical care, psychotherapy, or psychiatric care.  AR facilitation is not a substitute for any of the aforementioned. *
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