Expression of Interest

Working together is a collaborative process.

Please complete this form to express your interest. This helps me understand your goals, your context, and whether we are the right fit for the kind of work I offer. All information is confidential.

Contact

First name

Last name

Phone

Occupation

Relationship status

Where did you hear about me?

What brings you here now?

Briefly share what prompted you to seek support at this stage in your life or relationship.

What feels most important for you to address?

Please describe the challenges, questions, or patterns you’d like to explore

What have you tried so far?

Have you worked with other therapists, coaches, or resources in the past? What was helpful, and what wasn’t?

What outcome would feel meaningful to you?

If our work together is successful, what would feel different in your life, relationships, or sexuality?

Which package are you interested in?

Awaken (short-term clarity)

Immerse (deep dive)

Reclaim (long-term transformation)

Unsure – I’d like to discuss

How ready are you to commit to this work?

I’m ready to begin

I’m exploring my options but serious about change

I’m curious but unsure about next steps

Once I’ve reviewed your form, I will be in touch to arrange a confidential call to discuss next steps. Please note that I work with a limited number of clients at a time to ensure depth, privacy, and excellence.