What's next for your health, wellness, and personal evolution?
So you're ready for a shift. I'm glad you're taking your health and well-being seriously. I'd like to get a sense of what's going on in your life and what you'd like to see change, which this questionnaire is designed to provide.

Once you submit your answers, I'll review them within 1-2 business days and let you know by email if I think we'd be a good fit to work together. Then we can hop on a quick call to make sure.

Note: If you're a Willamette Valley local and you'd like to receive acupuncture and herbs with me, you need not fill out this form. Just call the office at (541) 757-4868 and we will set you up with an initial series of visits.
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Email *
Full name *
Phone number *
What major shift or breakthrough in your health, happiness, or personal evolution would you like to experience over the next year? *
What's prompting you to want to make this change now? *
Where are you at right now? Please check all that apply: *
How have you tried to solve this problem already? What's been helpful and what hasn't? *
Among the things I help people with are establishing healthy habits. Which of the following are you interested in? *
What could be keeping you from feeling how you want to feel? Again, check all that apply: *
My offerings catalyze deep transformation. They require energy, commitment to yourself, and are $1200-$3000 investments. If we determine we're a good fit to work together, are you prepared to invest in yourself at this level? *
How ready and willing are you to prioritize your health and personal growth at this time? *
Which offering are you most interested in? *
What is it about me or my message or approach most resonates with you? And how did you hear about my work? *
Is there anything else you'd like me to know?
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