Session Request Form

Thank you for taking this step. Please answer the questions below so I can better understand what brings you here and what you are carrying. Everything you share remains private and confidential. You will receive a response within 24 hours.

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Email *
Name *
Are you predominantly masculine or feminine in your biology
 *
Age (optional)
Where did you hear/learn about my sessions? *
Are you requesting an in person or online session? *
If in person, let's make sure we are in the same city. I'm currently based in Vienna, Austria. 
What city are you wanting the session?
Why are you feeling called to have a session? *
Please share your optimal session dates and time. i.e. mornings, evening, weekdays, weekends etc. *
On a scale of 1 to 10, how would you define your mental health? *
Unstable
Stable
Have you ever experienced or been diagnosed with any of the below? *
Required
Do you currently take or have you ever taken medications for any of the above disorders?
Thank you for taking the time to fill out the request form!
You will receive a response within 24 hours. 
If you do not receive a response within 24 hours, please check your junk mail folder.
A copy of your responses will be emailed to the address you provided.
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