Name *

First Name

Last Name

Phone

(###)

###

####

What themes would you like to address? *

Choose as many as you like

Nervous system regulation

somatics/ embodiment/ somatic experiencing

deconstructing childhood patterns/ beliefs/ traumas

strengthening relationship dynamics

emotional intelligence and communication skills

purpose and career direction

self-care and healthy lifestyle habits

other

How much time are you willing to commit to your healing journey each week? *

1- 3 hours a week

1 hour a week

1 hour bi-weekly

1 hour a month

other

Therapy and coaching is an energetic, emotional, financial and time commitment, how does that feel for you at this time? *

Yes, I'm ready to invest in myself, healing and creating the life I desire.

I have time and resources but I want to see if we are a good fit.

I am currently looking for free and/ or low cost support.

I mainly offer online support with the possibility of a monthly in person session in the Bay Area, would this work for you? *

Our online sessions do not require you to stare at the screen. There will be times with eyes closed, some movement, laying or lounging, an outdoor meeting or walking session is also possible.

Online sessions work!

Hybrid online and in person

Only in-person