Request edit access
New Client Inquiry
Thank you for your interest in working with me! This form is so I can get some information about you before we start working together.

At this time, I am only accepting new clients who sign up for one of my healing packages of either four or seven visits. Please see the Allies page on my website for referrals if you prefer to find a practitioner who offers single sessions.

I prefer to work in a deep way that allows my clients the time and space to do healing that reaches and transforms the root cause of their illness, whether it be physical, emotional, spiritual or ancestral. Time and regularity also allows us to build our relationship, and the relationship between healer and client is integral to any healing process.

Each healing package is uniquely designed for each person. After our initial consultation, I will create a roadmap of our work together. During our sessions together, I will draw from my years of training and experience in multiple modalities to create a specific recipe of healing for you.

After filling out this form, I will contact you to set up our first appointment.

Thank you,

Name *
Your answer
Birthday *
Email *
Your answer
Phone number *
Your answer
Gender pronouns *
Your answer
Best way to reach you? *
Who referred you to my practice? *
What issues or concerns would you like to address in our time together? *
Your answer
Have you seen other practitioners (medical or holistic) for this issue? *
If yes to the above, whom have you seen? *
Your answer
What are your healing intentions for yourself? *
Your answer
What offerings of mine are you interested in receiving? *
Any other questions for me? *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy