Contact info
I'm looking forward to getting to know you an supporting you in creating a relationship you love. Here are some questions that will help me to get to know you better so we can dive right in on our call.

Take a minute, drop into your heart and fill this out from a mindful place of reflection. This is as much for you as it is for me. Give yourself the gift of this moment to tap into your authenticity, your voice, and what you really want.

Thank you and know all info is confidential to you and me.

Email address *
Name *
Address *
Phone number
Emergency Contact Name, Phone, and Relationship *
What's going on in your relationship that brings you here?
What do you want to change or improve now?
What about your current situation upsets you the most? And how do you know you are upset?
What do you feel is holding you back?
If you had a magic wand, what your relationship look like? What would be different?
Have you worked with a Coach or Therapist before? What did you get from and what worked, what didn't work?
Have you ever been given a mental health diagnosis? Please share and let me know how you feel about that diagnosis.
Do you have epilepsy, seizures, asthma, or other severe medical conditions?
Is there anything else you want to share?
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