WELCOME!

Thanks for the opportunity to work together

Please take a minute to schedule your kickoff call and fill out the required intake form

STEP 1

Please pick a date and time for our first call. Choose a time where you feel you can be consistent on a weekly basis.

Your feedback will help me better understand how we will move forward. Anything you share with me is private and secure.

Name*
Date
Date Format: MM slash DD slash YYYY
Email
Phone*
What are you passionate about?*
Include subjects, fields of study, or professional work that interests you
Your current profession*
What professional field are you currently working in? What would you like to change?
What you want to achieve from our work together?*
List the three most important benefits you want to achieve
Have you been diagnosed with an illness, disease or disorder?*
If yes, please explain
Medications*
Are you currently taking medications pr substances? If yes, please list them.
Your primary relationship*
Are you married or in a relationship? Have you been divorced? How many times?
Children*
Do you have children? How many? Have you lost a child? Are you currently pregnant? Do you want to have children?
Parents*
Are your parents still married? Describe their relationship with each other. Describe your emotional relationship with them.
Family*
Are your family members still living? List them. Describe their attitude and issues, as you see them.
What do you feel is your best attribute?*
What three things do you do that brings you joy?*
Is there anything else?*
Please briefly share anything else that would be helpful to know about you, (i.e., recent life-changing events such as deaths, divorce, relationships, job changes, health issues, past trauma, accidents, etc.