First and Last Name
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First Name
Last Name
Birth date
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DD
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Gender & Pronouns
Email address
1. Please share briefly what is your motivation to seeking support at the moment.
2. What are the main aspects you want to address through embarking on a journey together? What is your intention?
3. How are you supporting your inner work at the moment? Do you have a daily practice? (meditation, breathing, journaling, etc)
4. What other resources do you have that support you? (close friend(s), family, practices, hobbies, interests, etc)
5. Healing, gaining insight & compassionate understanding requires full commitment to your own process. Please share how ready do you feel to embark on this journey and what do you need from me to support your full commitment.
6. Do you have any previous experience with counselling, therapy or other healing modalities? What were you seeking to address?
7. Do you consider that the process was successful? Why?
8. Are you currently dealing with any physical/medical condition? If so, which one(s)?
9. Are you currently taking any medication or supplements? If so, which one(s)?
10. Have you studied with any spiritual teachers/traditions? Which?
11. How did you hear about my services?
If applicable, at what age did you have your menarche? What did it mean for you?
If applicable, what does your menstrual cycle mean to you & how is your experience of it?
If applicable, do you change your life(style) in any way when you bleed?
Is there anything else you would like to add?
