Wellness Consulting
Intake Form

Thank you for your interest in
working with me!

This form will help me understand your needs and goals so I can tailor my support to best serve you.

Please take a moment to answer the following questions.

First name*

Last name*

Your email*

Phone number*

What are your primary wellness goals?*

What challenges are you facing in achieving these goals?*

Current Practices - Do you currently engage in any wellness practices? (e.g., yoga, meditation, therapy, etc.)*

Yes

If Yes, please describe:

Are there any specific modalities or practices you're interested in exploring?

Have you worked with a wellness coach, mentor, or therapist before?*

Yes

If yes, what was helpful or not helpful about that experience?

Are there any past traumas or health conditions I should be aware of to better support you?*

How do you prefer to receive support? (e.g., one-on-one sessions, group programs, virtual, in-person, etc.)

What is your availability for sessions? (e.g., days/times that work best for you)

Do you have a specific budget or timeframe in mind for this work?

Is there anything else you’d like me to know about your needs, preferences, or expectations?

Wellness ConsultingIntake Form