Attachment Repair Meditation Guidance Client Intake Form
Please note that Attachment Repair (AR) Guided Meditation facilitation is supported by a healthy diet, regular physical exercise, good sleep hygiene, healthy social engagement, an established livelihood, spiritual practice/meditation, medical care, psycho-therapy, or psychiatric care. AR facilitation is not a substitute for any of the aforementioned.

-Regarding the form - just fill out whatever is relevant. No need to fill out the whole form if you don't want to.
Email *
Name *
Brief description of psychotherapy background. Have you been to therapy and if so, how long did you go to therapy? What type of therapy was it? Why did you go? What were the results of going to psychotherapy for you?
Which of the follow describes you?
Brief description of meditation practice background. Have you practiced meditation and if so, how long have you been practicing and how much? In which traditions have you practiced, which practices?
Which of the follow describes you?
In a sentence or two why are you interested in attachment repair?
This question and the one following it give us a hint as to what your attachment style might be: My general assumption is that others are trustworthy and want what is best for me.
Clear selection
Please select the one that best describes you:
Clear selection
What do I need to know about you that will help me guide you best and help you feel comfortable and at ease?
Are you in a place where you are willing to practice the Attachment Repair meditation for 20 to 40 minutes, three to six days a week with the goal of moving your underlying attachment conditioning from insecurity to security?
Clear selection
I charge US$150 per 50 minute session going forward. In the case that you find Attachment Repair facilitation very compelling, is this a financial possibility for you? It's recommended to do Attachment Repair facilitation once a week, once every other week or Once a month also works.
Clear selection
What time zone are you in?
What days of the week and times of day generally work best for you? - Select all that apply.
I understand that Cedric Reeves is a meditation instructor and not a therapist, psychotherapist, counselor, psychologist, or psychiatrist. The Attachment Repair guidance offered is offered as guided visualization meditation. *
I understand that any advice given is not intended to supplant or contravene the advice of my medical doctor, psychologist, psychiatrist, counselor or any other wellness professional. *
I understand that Attachment Repair (AR) Guided Meditation facilitation is supported by a healthy diet, regular physical exercise, good sleep hygiene, healthy social engagement, an established livelihood, spiritual practice/meditation, medical care, psycho-therapy, or psychiatric care. AR facilitation is not a substitute for any of the aforementioned. *
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