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1-1 Session Inquiry - Fears & Phobias Intensive
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Your name
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Your answer
Your email
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Your answer
How did you hear about me?
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Instagram
TikTok
Youtube
I heard you on a podcast
I read one of your books
Internet Search
Other:
What is the fear or phobia that you would like to get rid of?
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Your answer
Do you know why, where, or when it started for you? If so, please share briefly.
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Your answer
How intense is this fear or phobia for you?
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1 (least intense)
2
3
4
5
6
7
8
9
10 (most intense)
How much does your fear or phobia interfere with your life?
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1 (extremely rarely)
2
3
4
5 (occasionally)
6
7
8
9
10 (on a daily basis)
Is there anything else I should be aware of? Do you have any questions or concerns?
Your answer
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