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First name

Last name

Phone

If someone referred you, please include their name here:

What drew you to this 6-Month Immersion Program?

Have you attended a retreat, workshop, or course with me before? If so, which one(s)?

Tell me a little about where you are in your personal growth or healing journey right now

What are you currently exploring or working through in your life?

What do you hope to experience, learn, or shift through this program?

Are you currently in therapy, coaching, or another healing modality? (If so, how might this program complement that?)

What would “liberation” or “healing” mean to you at this stage of your life?

Is there anything you’d like me to know about your journey, needs, or intentions before we begin?

Can you commit to fully participating in the live sessions and keeping absences to a minimum (no more than 1 per month)?

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