Before we begin

Client Intake Form

A little context helps our work together be more precise. Please answer as honestly and completely as you can.

Everything you share here is kept confidential and used only to inform our work together.

About You

Current Health

Are you currently experiencing any of the following? If yes, add a little detail below.

Heart problems
Migraine or epilepsy
Physical pain or injury
Specific fears or phobias

A Little Background

Have you ever been diagnosed with a psychological or psychiatric condition? If so, share whatever feels relevant. Have you spoken with your GP or doctor about what's bringing you here? Is there any other health condition worth me knowing about? Are you currently taking any prescribed medications? Do you experience IBS or other digestive issues? Do you tend to carry tension in a particular part of your body?

Daily Rhythms

Have you used recreational or non-prescribed substances, now or in the past? How would you describe your sleep? (falling asleep, staying asleep, waking early) How much movement or exercise is part of your week?
The information I've shared above is accurate and complete to the best of my knowledge.

Thank you

Your intake form has been received. I'll review it ahead of our first session together.