Hey! I really look forward to working with you and am stoked you're ready to take action! 

This form is the opportunity for me to get to know you a bit better. Some of these questions may be hard for you to answer. Do your best as they will help me get a better understanding of where you and your nervous system are at.

All answers and any discussions is kept confidential.

Please don't hesitate to reach out if you have any questions, otherwise I will be in touch soon to arrange our first session if we haven't already done so. 

Congrats on taking a step in making a change!

xo Nicole


Name *
Name
How would you describe yourself?
What can you best relate to? (Click all that apply)
How comfortable are you with doing nothing!?
How's your current support/friend network?
How well do you sleep?