This application helps me determine whether 1:1 nervous system coaching is the right fit for you at this time. Please take your time and answer each question honestly and thoroughly.
This is not therapy or medical treatment. If accepted, you will be required to complete additional intake forms before beginning coaching.
Incomplete applications may delay review or may not be considered.
Select all that apply
Chronic stress or burnout
Anxiety or nervous system dysregulation
High-functioning but exhausted
Major life transition (identity, relationship, career, motherhood, etc.)
Feeling disconnected from my body
I’m not sure, I just know something needs to change
No elements found. Consider changing the search query.
List is empty.
1 Not at all
2
3
4
5
6
7
8
9
10 Never been more ready
No elements found. Consider changing the search query.
List is empty.
Select all that apply
Structure & accountability
Nervous system education
Somatic tools & embodiment
Emotional support & integration
A combination of the above
No elements found. Consider changing the search query.
List is empty.
Yes
No
Somewhat / on and off
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List is empty.
Yes
Mostly
Not at this time
No elements found. Consider changing the search query.
List is empty.
Yes
I think so
No
No elements found. Consider changing the search query.
List is empty.
Yes
Somewhat
No
No elements found. Consider changing the search query.
List is empty.
Yes
I'd like to discuss options
No
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