Heal Trauma, Deepen Connectedness,
Build Resilience, Transcend Addiction,
Cultivate Peak Performance,
One Breath at a Time
Somatic Psychotherapy
Intake Form
Security features provided by the host site, Wix, are active. However, I cannot guarantee their effectiveness. Please feel free to utilize an alternative format to the page below - a fillable pdf or hard copy will be sent upon request.
Please take your time and provide only the information you are comfortable sharing at this point. More can be shared in time.​
Feel free to give yourself bio breaks, stretch, get fluids and exhale.
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After this, please proceed to
Disclosure Statement & Agreement for Services
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If you would like me to consult with other practitioners related to your healing and personal development story, I need you to complete a Release of Information
form for each individual or agency. This must include specifically what you wish to be shared, as well as the purpose.
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The Core Gift Questionnaire is the first step of an interview and sorting process that results in your Core Gift Statement. It identifies strengths, skills, talents, gifts - as well as your Core Gift - unique to you, and you use all the time, for better and worse.