Welcome 

I can't wait to get started!

Thank you for booking a session with me. Before we meet, please take a few moments to complete this form. Your honest reflections help us begin our work together with clarity and care.


Client Intake Form


What feels hardest for you right now?*
What are you hoping to shift, change, or understand?*
Where do you feel stuck?*
What would feel different if this work was successful?*
If I had a magic wand, what would you like to leave the session with?*
Are you currently seeing a psychologist, therapist, psychiatrist, or other healthcare professional?*
Have you ever been diagnosed with a mental health condition?*
Are you currently taking medication for mental health support?*
Have you experienced severe trauma, psychosis, dissociation, suicidal ideation, or hospitalization for mental health concerns?*
Is there anything important I should know to support you safely during our work together?*
By participating, you confirm you have disclosed any relevant medical or psychological conditions that may impact your participation.*
You acknowledge that you are responsible for your own decisions, actions, wellbeing, and participation throughout the coaching process.*
You acknowledge that participation in these services is voluntarily.*
You understand that all personal information is confidential and will be shared only buy exception in the case of physical harm or injury, as required by law, or with written consent.*
You understand that 24 hrs notice of cancellation is required or the full session fee is payable.*