Name
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First Name
Last Name
Email
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Gender identity and pronouns
Have you done therapy, coaching, or other healing work before? If so, what approaches or modalities have you tried?
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Do you currently have support systems in place (therapy, community, family, friends, other practitioners)?
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Are you currently navigating any major life transitions, medical conditions, or crises that you’d like me to be aware of?
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What feels most important for you to receive support with right now?
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How do you typically support yourself when your stressed? (it's okay if you don't know).
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What feels supportive for you in a practitioner (for example: warmth, structure, space to process, education)?
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What do you desire your life to look and feel like from our time working together?
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How would you prefer to receive communication from me?
Which feels familiar?
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On a scale of 1 - 10, 10 = high, how would you rate the quality of your life today?
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On a scale of 1-10, 10 = high, what is your current level of stress (on average)?
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On a scale of 1-10, 10 = high, how ready do you feel to begin this work? (note: resistance is normal)
Somatic work requires consistency, and my packages include 4 or 8 months of bi-weekly sessions to start. You can also book single sessions. Pricing ranges from $200-$370/mo. Does this sound aligned for you?
Which of the following appeal to you? (Pick as many as you'd like)
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Please share anything else you'd like me to know.
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