Is This the Healing You’ve Been Searching For?

Take this free 2-minute assessment to uncover what may be keeping your body in survival mode and discover if you’re a fit for the Experiential Healing program. Once you submit your answers, I’ll review your results and reach out with next steps.

Personal Information

First name

Last name

Email

Age

Current Health Concerns

What are your primary health concerns? (Select all that apply)

How long have you been experiencing these issues?

Less than 6 months

6 months to 1 year

1-3 years

Over 3 years

Previous Health Interventions

Have you previously worked with a health coach, therapist, or medical professional for these concerns?

Yes, with a health coach

Yes, with a therapist

Yes, with a doctor or specialist

No

Which approaches have you tried to manage these issues? (Select all that apply)

Have any of these approaches brought relief? If so, please describe briefly.

Readiness for a Trauma-Informed Approach

Are you open to exploring how unresolved trauma may be impacting your health?

Yes

No

Not sure, but willing to learn more

How familiar are you with the mind-body connection in health and healing?

Very familiar

Somewhat familiar

Not familiar

Commitment Level

On a scale of 1-5, how committed are you to investing time and effort in your healing journey? (1 being not committed at all, 5 being fully committed)

How willing are you to explore new approaches, including both scientific and trauma-informed methods, to improve your health?

Very willing

Somewhat willing

Not very willing

Goals and Expectations

What are your primary goals for working with a health coach? (e.g., relieve specific symptoms, gain energy, address root causes, etc.)

What outcome would make you feel that your healing journey was successful?

Additional Information (Optional)

Is there anything else you would like to share about your health journey or goals?