Let's see how we'll be working together!

Our professional relationship is going to be based on understanding each other's strengths, goals, and areas of concern. By filling out this survey, you'll take the first step toward improving your commitment to your personal growth and help understand which of my services are best for you. I appreciate you taking the time to answer these questions with transparency and accuracy so we can move closer to helping you develop the best strategy. If your needs exceed my services, I'll be happy to recommend a referral. Let's get started!

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* 1. What are your short term goals? Check all that apply.

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* 2. How would you describe your current situation? These questions are crucial to answer because your safety and well-being is of utmost importance. These questions help assess risk and whether my services are right for you or if you'd be better served by someone with different skill sets. I want you to receive the best attention possible.
Disclaimer: My services are part of the healing arts and/or professional development. I am not a licensed therapist or medical professional. I may refer you to someone else or another service, depending on your needs.
Privacy: Your answers are kept confidential and I never, ever share your information with anyone. If I suggest a referral, I'll be providing you with referral information, not sharing your information with anyone else.

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* 3. Are you currently or have you been in therapy to address the issue you're writing to me about now? (your answers are never shared).

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* 4. What services are you most interested in? (check all that apply)

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* 5. How would you describe your personal style when it comes to learning new things or being receptive to information and feedback?

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* 6. Please list your contact information and when you would like to get started (your information is never shared).

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* 7. Have you ever received the kind of service(s) you're looking to receive now?

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* 8. If you answered "Yes" above, please describe your experience receiving the service.

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* 9. Please sign me up to receive your newsletter about your full spectrum of services including special offers, workshops and events (your information is never shared and I'll never spam you).

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* 10. How did you learn about my services?

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