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Consultation Form

Considering becoming a client? Please fill out an intake form before our session to make sure you are a good candidate for services, and to have sessions tailored to meet your needs.

 

Be sure to add any relevant information that you want to share to enhance your therapeutic experience. 

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What service are you interested in?
Have you ever tried any of the following modalities? (Check all that apply)
Have you had any form of Psychotherapy (talk therapy)?
yes
no
Are you sensitive to any of the below elements that may be incorporated into visualizations? Check any that apply.
Any allergies to essential oils that may be used in aromatherapy (lavendar, cedarwood etc.?)
yes
no
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