Intake Form - Journey into Your Authentic Integrity
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Are you ready to adventure into your Authentic Integrity in a private one-on-one container?  As a Yoga Therapist & Professional Certified Coach, I help you connect to your own Authentic Integrity through various practices to help you connect, reflect and direct yourself with your own unique self-leadership.  I am your trusted guide to help teach you tools and practices to return to yourself and define your path forward on your journey.  

Take a few moments to complete this form so we can start getting clear on your needs.  Once you submit it, I will review and email you back with a link to schedule a Discovery Call.  We will spend some time getting to know each other, your needs and how I can help you on your adventure to living boldly in authenticity and integrity.  Let the journey begin!
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Email *
Your Full Name *
What do you like to be called? *
Phone number *
Are you ready to adventure into your own Authentic Integrity? *
No, I am in a state of dysregulation (Fight, Flight, Freeze, Fawn)
I'm ready for the adventure - I want to live fully and completely.
What motivated you to seek support in discovering your Authentic Integrity at this point in your life?  
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 Describe a recent situation where you felt disconnected from your true self. What do you believe contributed to that feeling?  
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What areas of your life (e.g., career, relationships, health) feel out of alignment with your core values right now?  
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Required
 What changes or growth are you hoping to experience through this process?   *
 What do you think is currently preventing you from living in full alignment with your authentic self?  
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How do you handle challenges, especially when your decisions or actions conflict with your values or integrity?  
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 What does success look like for you in terms of living from your Authentic Integrity?  
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How would you assess yourself on accessing your intuition *
Disconnected and unable to access
Highly connected
 Are you open to exploring new perspectives and making uncomfortable changes to align your life with your inner truth? Why or why not?  
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How would you assess your readiness for authenticity? *
Oh hell no - I have to wear the mask each day and hide myself to fit in
I'm ready to be me and live the adventure of my Authentic Integrity
 How would you describe your current support system? How do they influence your personal growth?  
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What personal strengths or qualities do you feel will support you in this journey of discovering your Authentic Integrity?  
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 What scares you most about stepping into your authentic self-leadership?  
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What goal would you like to work towards? *
What would you do if you were not afraid of guilt, blame or shame? *
Is there anything else you want me to know about you or your journey as you begin this process?  
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