Please fill the form below. This information is kept confidential. If you’d like to do couples work, please fill out this form separately. Name * First Name Last Name Email * Age * Are you in a romantic relationship or married? For how long? Do you have any children? What would you like to explore with me about your romantic relationship(s)? * Are you in touch with your parents? How is your relationship with them? * Do you carry trauma? Please explain. If yes, how is it impacting your life? * Do you have any active addictions (including porn)? Please briefly explain. How would your life be without this addiction? * Have you been in therapy or counsellng before? What didn’t work for you about the work you’ve done previously? What more would you like to explore this time? * Do you have a spiritual practice? If yes, please explain. How often do you practice? What seems to be missing in your spiritual practice or tradition? * How did you hear about me? * Please add any additional information or comments. Thank you!
