1:1 Client Intake

Please fill out the form below at least 24 hours before our first private coaching session.
Thank you. I am so excited to begin working with you!

Name *

First

Last

Email *

Address *

City *

Province/State *

Postal/Zip Code *

Country *

Please share a brief history about yourself: *

What are your main reasons to begin 1:1 coaching with me? *

In order of priority, list your top 3 main struggles right now: *

What is your biggest challenge when it comes to overcoming the struggles listed above? *

What are your current self-healing practices? *

What are you hoping to receive from our 1:1 coaching sessions? *

Are you working with any other practitioners at the moment? If so, please share: *

Please share any additional information with me that you feel is relevant before we begin our 1:1 coaching: *

CANCELLATION & NO SHOW POLICY

I understand that I am required to give 24 hours notice if I want to cancel or reschedule a 1:1 session. If less than 24 hours notice is given, I will be charged for the full session rate.
I understand that if I do not show up for a session within 15 minutes of the session start time, I will be charged the full session rate.

Message