Application

Name*

First Last

Date of Birth*

Email*

Have you worked with a therapist before? If so, when? Please share more details about your experience.*

Have you ever been hospitalized, suicidal, mentally unstable, or diagnosed with a severe mental illness (such as schizophrenia or severe bipolar disorder)?*

True

False

When did this occur? Please share more details about your experience below:

How active are you willing to be in your soulful journey? Please choose the sentence that describes you best.*

I would like my problems solved for me, thanks!

I don’t want to have to do everything but I’m willing to participate where required.

I’m active, but I tend to become inactive when I’m resisting change! I want help with this too!

I’m an active participant and engage in deep inner work even when I’m not in therapy.

What’s your main intention for working with us? Please choose the sentence that describes you best.*

I have a longing to fulfill my soul’s calling but I don’t know what that calling is yet.

I feel a transformation stirring in me and I need support to find my way through it.

I want to express myself more fully and I need support to uncover and move through those blocks to my self-expression.

I keep repeating the same patterns in my relationships, career, and life in general and I want to change those patterns and feel more liberated.

I want to work with my childhood trauma more deeply to uncover its gift and learn how to manage my vulnerabilities with it.

Other

Is there anything else you would like to share that would be important for us to know?

How did you hear about us?*

Would you like to join our mailing list?*

Yes, sign me up

No thanks, not right now

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Due to the depth this therapeutic work requires, we would like to get to know you a bit more. Please answer the following questions:

The world is hungry for your unique creativity, expression, and vision!