Form & Focus 
Thanks for your interest in working with me. 
I use this intake form as a way to get to know you and your needs better. 
This information is treated as confidential and is never shared with third parties. 
If you are not comfortable sharing some details, you can let me know when we meet.

Name *
Email *
What kinds of issues do you want help with? *
Are you currently attending any other forms of therapy or taking medication ? 
Please share a brief overview.
 *
*
What kind of supports do you already have in place?
What is you name at birth, date of birth and place of birth? ( for Soul Realignment® bookings)
How do you intend your life to change 
( for the better ) over the next six months?
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