Your First Step to Freedom Starts Here
Before we meet for your intake session, I need you to complete all the forms listed below. I know some of the questions may feel personal—and that’s intentional. The truth is, the emotional blocks that are holding you back often come from past experiences your brain is still protecting you from. These forms help me get a fuller picture so we can get to the root of what’s been keeping you stuck. My goal is to help you clear those hidden traumas and create fast, lasting change—and it starts here.
This is a list of people, places, animals, or experiences—past or present—that have brought you a sense of unconditional love, safety, or support. Think of mentors, beloved pets, benevolent ancestors, spiritual figures, kind neighbors, teachers, or even a peaceful place in nature. These positive connections can be powerful anchors during our work together, helping your nervous system feel safe as we process deeper blocks.
This form helps you identify which negative thoughts are most active in your life right now. You’ll rate how strongly each thought impacts you on a scale from 0 to 10. This isn’t about judgment—it’s about awareness. The thoughts that feel the heaviest often point to the emotional blocks we’ll be clearing in our work together.