This brief form helps ensure our conversation

is appropriate, focused, and supportive.
This is not a crisis service or therapy intake.
Please answer thoughtfully.

First Name *

Last Name

Email *

Phone

What prompted you to request this conversation at this time? *

Have you experienced a disruption to your sense of identity or direction? If so, how would you describe it? *

What are you hoping to gain clarity or support around through this work? *

Have you previously worked with a coach, therapist, mindfulness teacher, or similar support? *

This work emphasizes awareness, attention, and personal responsibility rather than quick fixes. Does that align with what you’re seeking?

Please confirm your understanding of the following (check all that apply): *

This conversation is not therapy or crisis support

I am not currently in immediate psychological crisis

I understand this is a reflective, mindfulness-based conversation

I am willing to engage thoughtfully and respe

Is there anything you feel would be helpful for me to know before we speak?

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This brief form helps ensure our conversation

is appropriate, focused, and supportive.This is not a crisis service or therapy intake.Please answer thoughtfully.

is appropriate, focused, and supportive.
This is not a crisis service or therapy intake.
Please answer thoughtfully.