Registration Form

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Registration Form

Lets get to know you a little, I meet you where you are!

Email *

Name *

Telephone *

What times are you available?

Please select all that apply

Morning

Midday

Afternoon

Evening

Monday

Tuesday

Wednesday

Thursday

Friday

Intentions

What is drawing you toward The Alignment Room at this time?
*

What is your current emotional or internal state?
*

What type of experience are you seeking? (check all that apply)
*

Emotional release

Spiritual clarity

Deep rest & Stillness

Grounded reconnection with Self

Sound + Somatic relief

Other (please describe)

Required

Experience Type

Which experience are you inquiring about?
*

Stillness Session (quiet rest + grounding)

Sound & Somatic Immersion (restorative + emotional unwinding)

Emotional Reset Session (guided calm + inner loosening)

Not sure — please recommend

Practical Details

Are you located in the Hudson Valley or requesting travel?
*

Hudson Valley / New York

Another state (travel request)

Virtual session

Not sure

Preferred session window
*

Weekdays

Evenings

Weekends

Flexible

Readiness & Boundaries

Are you currently in therapy, coaching, or another healing relationship? Yes or No (Optional Explanation)
*

Is there anything I should be aware of to support your experience safely and intentionally?
*

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