Expression of Interest to Work With Me

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Please complete this form if you are interested in working with me therapeutically. Please note I am currently only taking enquiries for clients seeking Yoga Therapy and Integrative Yoga Psychotherapy due to limited availability.

This form is designed to provide some initial information for what you would like to support with, so I can understand your hopes for therapy and how you are hoping to work together.

I will then review the information and get back to you via email to discuss if I think we would be a good fit, chosen modality, and availabilities. When my case load is busier I operate a waiting list. We can then begin straight away or you we can arrange an initial 20 minute call or zoom if you have questions or would like to get a feel for how I work.

I appreciate your interest in working with me and taking the time to complete the below information.

Full Name *

Pronouns *

She/her

He/him

They/them

Prefer not to say

Other:

Email Address *

Contact Number *

Are you enquiring for Yoga Therapy or Integrative Yoga Psychotherapy? *

Yoga Therapy

Integrative Yoga Psychotherapy

Not Sure / Both

Are you ready and willing to actively engage in the therapeutic process, including curiosity, honesty, self-reflection, implementing changes and, where applicable, engaging in relevant home practises *

Please select the reasons you are looking for therapy at this time *

To support a diagnosed mental health condition/s

To support a diagnosed physical health condition/s

To improve mental wellbeing (no current mental health conditions to be supported)

To improve physical wellbeing (no current health conditions to be supported)

Significant life challenge (eg. grief, job loss, specific trauma)

Other:

If you answered ‘Other’ please feel free to use this box to expand more

Please provide a brief context of what you would like to bring to therapy and what you would like to achieve *

Have you attended therapy or other holistic offerings before? If so, what worked well for you and what didn’t *

Are you currently working with another health professional, including other therapists, GP or other medical professional *

What is your availability for sessions? Please check all that apply

Morning (9am-12pm)

Afternoon (12-5pm)

Early evening (5-7pm)

Wednesday

Friday

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