Application for free 20 minute consult:
Hello Dear One,

I'm finally taking new clients again for both online work and in-person work in my new home in qathet, aka Powell River, BC. This is exciting for me ~ I have about 6 spots as of August 2021 and I can't wait to see who fills them up :)

So, I'm so glad YOU made it here...
One thing to consider is that filling out this application form can also serve as an opportunity for some deeper reflection for you, if you want, so I want to invite you to take your time with it, go slow, and fill it out thoughtfully.

Though you might also be in a place where it's more like, "Must get support now, writing about my shit right now is too much." And that's also okay, then in that case just keep it simple.

By the way, also, I'm the only one who reads these, not even my assistant comes in here, this is a secure form and I abide by the ethic of confidentiality as laid out by the Association of Cooperative Counselling Therapists.

There are, however, the following exceptions to confidentiality: i) When disclosure is required to prevent clear and imminent danger to the client or others; ii) When legal requirements demand that confidential material be revealed; iii) When a child or one from the vulnerable sector is in need of protection.

So now that we're clear, know that I treat the words you do share as sacred, and I look forward to hearing from you very much.

Josea Tamira Crossley, RTC
Sign in to Google to save your progress. Learn more
Email *
Name *
Phone number
Tell me a little bit about why you're reaching out ~ just what's comfortable to put in writing here, no more no less, we'll also get to speak on the phone. ;-) *
What are some of the more challenging pieces? *
Mark your TOP 3 most challenging things, (if you could have these handled life would be rosier):
What nourishes you? What keeps you grounded? When things aren't okay, how do you bring yourself back to 'okayness'? What are your best resources at this time? PS: Sometimes the things that support us to cope are also the things that harm us. That's possible too and you won't find any judgement here for that, just maybe some help to find nourishment that's more fully in alignment with your highest good. *
What is the thing that you think I might be able to help you with? If you could shift ONE thing in the next 3-6 months, what would it be? *
Imagine ~*~ you're holding a magic wand and **poof*** ...You've now got a better relationship with that THING that plagues you . How does it FEEL to be on the other side of that? What are some emotions you might be experiencing if your relationship to this part of you was how you want it? Do you feel more FREE? What else?? *
How committed are you to making the transformation you need to make so that you can feel the way you want to feel?
Clear selection
What do you think is the biggest thing in your way of getting where you want to go?
Is there anything else that might be helpful for me to know so I can serve you better?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy