Hello!

It's a pleasure to meet you. Please take a few moments to fill out the following form. It will take anywhere between 15-30 minutes and if anything, is a wonderful resource for yourself to get to know (and listen) to you through a variety of questions. 

NAME *
NAME
DATE OF BIRTH *
DATE OF BIRTH
THE FEELINGS SECTION
Please take a moment to settling into your body and describe how you currently FEEL and how you want to FEEL in each of these areas of your life. If you’re a numbers person, also may also simply rate yourself on a scale of ‘0 – 10’ of where you are today vs. where you really want to be (10 is where you ultimately want to be). It can be short and sweet bullet points or long and winded paragraphs. Whatever is calling you.
(intimate, friends, family, co-workers, etc)
VISIONS
Please take a moment to list three things that you want / that would make you happy that you are absolutely ready to take immediate action on (that you would like to accomplish in the next 6-9 months).
TIE IT ALL TOGETHER
Do you best you can to answer the following questions. If at all if feels overwhelming, take a moment to check in with yourself and feel free to leave a section blank. Remember, there is not perfect answer, only your truth.