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Program Application

Begin Your Journey Within

This application is the first step toward a 12-week psychospiritual journey.

Take your time. there are no right answers – only those that are true for you.

Approx. 10-15 Minutes to complete

"*" indicates required fields

About You

First Name*

Last Name*

Email Address*

Phone Number*

Date of Birth*

MM slash DD slash YYYY

City & State*

What is your occupation?*

· · ✦ · ·

What's Bringing You Here

Where are you in your life emotionally, psychologically, creatively, or spiritually? And what is calling you toward this program right now?*

Which of the following best describes what you are seeking? (Select all that apply)*

Deeper Self Understanding and Inner Clarity

Greater Creative Expression and Authentic Voice

Healing Unresolved Wounds or Familial Patterns

Clarity about Life Purpose or Direction

Spiritual Deepening and Connection to the Self

Greater Empowerment and Inner Authority

· · ✦ · ·

Your Inner Work Background

Have you engaged in a therapy, counseling, or coaching before?*

No - This would be my first experience.

Yes - Some experience in the past.

Yes - Significant therapeutic background

Yes - I am currently in therapy.

If you’ve been in therapy before, what approaches or modalities have you worked with?

Do you have a current spiritual or contemplative practice?*

Not Currently

Occasionally - It comes and goes.

Yes - I have a regular practice.

Yes - It is central to my life.

Briefly describe your practice, if you have one.

How comfortable are you with exploring symbolic material — dreams, images, archetypes? *

Entirely new to me

Somewhat unfamiliar

Moderately familiar

Quite comfortable

Deeply at home here

· · ✦ · ·

What You Hope to Transform

What would genuine transformation look like for you at the end of these 12 weeks?*

What do you sense might be the greatest obstacle to your own transformation?*

Why do you feel ready for this work now?*

· · ✦ · ·

Practical Details

What is your general availability for weekly sessions? (Select all that apply)*

Weekday Mornings

Weekday Afternoons

Weekday Evenings

Weekends

Is there anything else you’d like us to know about your availability?

Investment — which payment option are you considering?*

$3,000 - Pay in Full

$1,050/month for 3 months

$275/week for 12 weeks

I'd like to discuss this on the call.

How did you find us?*

Is there anything else you’d like us to know before your assessment call?

Would you like to join our mailing list?*

Yes, sign me up

No thanks, not right now

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By submitting this application, you are expressing your genuine intention to begin. We will review your application and contact you within 2–3 business days.

The world is waiting for what only you can bring.

Join our monthly newsletter and receive a free gift — two practices to help you tend the flame of your unique inner life.

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