First Name *

Last Name *

Phone *

Email *

What time zone are you in? *

What is your trauma? *

When did your trauma occur? *

Describe briefly what trauma looks like for you. *

How have you dealt with trauma? *

What method have you used to redue your trauma? (positive & negative) *

What would your life look like if you were able to live beyond your trauma? *

Have you ever had professional help? (therapist, psychiatrist, pastor, counselor, and/or a life coach) *

Yes

If you were interested in us helping you, when would you be available? *

Is there anything else you'd like Tracey to know? *