Before We Begin | Website Online

Welcome. Before we meet, I want to understand who you are and what is moving in you right now. This is not a test. There are no right answers. Your honesty here is the most important thing.

Pour yourself a cup of tea, find a quiet moment, and come back when you are ready. This form takes about 10 minutes. Once I have reviewed it I will be in touch within 3 to 5 business days.

What is your full name?

Birthday

Phone

Where in the world are you? Please include your country and time zone.

What is bringing you here right now? What has been happening, or building, that led you to this moment?

What are you most hoping to shift, heal, or understand through this work?

Have you done any previous inner work? This might include therapy, IFS, somatic work, EMDR, shadow work, spiritual retreats, or ceremony. If yes, what has that been like for you?

Do you have a spiritual practice, ceremonial practice, or any regular practice that helps you feel grounded and connected? Please describe.

Do you have any experience with plant medicines or entheogenic substances? If yes, please share which medicines, in what context, and how those experiences have shaped you.

How is your mental and emotional health right now? Are you in a stable enough place to open into difficult or tender material?

Have you ever been diagnosed with or experienced psychosis, schizophrenia, or bipolar disorder with psychotic features? Please describe briefly.

Are you currently taking any pharmaceutical medications, including psychiatric medications? If yes, please list them.

Do you currently have a therapist, doctor, or other support person in your life?

What does your support system look like right now? Who do you have around you?

Is there anything about your life circumstances right now that might make it difficult to commit to regular sessions or between-session practices?

Is there anything you want me to know about you that this form has not asked?

I understand that this work involves emotional and psychological exploration. I acknowledge it is not a substitute for psychiatric care or emergency support. I confirm that all information I have shared is true.