Intake Form

Thank you for your desire to heal and grow into your most full self.

Here are a few things I would like to know about you before we share time together, 

Please answer wholeheartedly. All answers are kept confidential.

NOTE: Because you will NOT be able to save your answers once you begin, I suggest that you read through this form once, then pre-write your answers, and then copy/paste them into the form at once.

Name *
Phone* *

What I Request From You:

Respect of Boundaries Established Within Each Session
A Desire to Nurture Heart Connection
Willingness to Grow and Change
Eye Contact

What I Do Not Want In My Sessions:

Being touched without consent
Looking for a quick fix
Expectation of a performance

Please note that I reserve the right to end a session early if my boundaries are not respected.

Can you meet the above boundaries with a "Hell Yes"? Are there any that do not resonate well with you?


Thank you for your sharing

I look forward to guiding and supporting you on this soul journey