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PRIVATE THERAPY OR COACHING

Please complete and submit the following form.
Please note: I will be off the grid between May 31-June 24 and will respond to all messages received after June 25.
A complimentary thirty-minute phone consultation to explore the possibility of working together may be scheduled here.

Name *

E-mail *

Confirm E-mail *

Phone Number *

Current Location (City) *

Which of the following are you interested in? Check all that apply. *

Private Therapy One-on-One Coaching Online Courses Retreats & Workshops

What is your level of experience with individual or group therapy and/or coaching? *

Which areas would you like support with? (check all that apply) *

Relationships Dating Love Sex Self-Love, Self-Esteem & Self-Worth Codependence Kink/BDSM Trauma Addictions Mental & Emotional Health Physical Health Conflict & Communication Major Life Transition Life Purpose & Meaning Friendships & Community Spirituality Career Finances I'm not sure Other (describe below)

Which three of the above areas would you like to address first? *

What is the single greatest struggle you have right now? *

Describe your dream outcome from our work together. *

How would you like to connect? (check all that apply) *

Online Video Phone In person

Is there any additional information that you would like to share with me at this time? *

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Ready to restore your peace and reclaim your joy? Click here to schedule your complimentary 30-minute consultation now.

Home
About
Work with Me
Couples
Blog
Contact

PRIVATE THERAPY OR COACHING

Home

About

WORK WITH ME

BLOG

CONTACT