Client Interest Form

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Thank you for reaching out about my services! Before we get on a free discovery call, please take some time to answer these questions! I want to make sure that I am the right fit for your journey, and that you are the right fit for my programs! Thank you so much!

Email *

Date *

YYYY

Name/ Pronouns *

Are you in therapy/have you been in therapy recently? *

Yes

Are you in recovery? *

Yes

How much sobriety do you have if so? *

Are you at a place in your life to commit at least 2 hours a week to this work? *

Yes

Maybe

Are you able to financially invest in a program, and in yourself? *

Yes

Are you committed to yourself to make the changes in your life to reach the goals you are desiring? *

Yes

What Is Your Number #1 goal you are seeking to achieve with support? *

Have You Started healing in the past and found it difficult to stick with it? If so why do you feel it was hard to stick with it? *

What is stopping you from achieving the life you desire? *

Send me a copy of my responses.

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