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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.

I am currently on a writing sabbatical and am not taking new clients until March 2021. Please complete this form to be added to my wait list. I will reach out to you next year if you are still interested.

Thank you,

Name *
Birthday *
Email *
Phone number *
Gender pronouns *
Best way to reach you? *
Who referred you to my practice? *
What issues or concerns would you like to address in our time together? *
Have you seen other practitioners (medical or holistic) for this issue? *
If yes to the above, whom have you seen? *
What are your healing intentions for yourself? *
What offerings of mine are you interested in receiving? *
Any other questions for me? *
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