Confidential Client Intake Form

The information you provide here will be kept confidential and will be helpful in knowing how best to support you. Please answer each item to the best of your ability.


My standard rates are $150/hour.

The first, 30-minute consultation is complimentary/free.

If these fees are prohibitive, please send me a message explaining your situation. I am open to renegotiation anytime so our exchange feels sustainable for us both. I ask that clients commit to 4 sessions before deciding to continue.

Cancellation Policy

I am only able to offer a limited amount of appointments per week. The appointment time I save for you is specifically for you and while I often maintain a wait list, I cannot book someone at the last minute. Appointments canceled without at least a 24-hour notice will be subject to a $75 cancellation fee for the first appointment missed and the full fee thereafter. We ask that you please reschedule or cancel at least 1 day before the beginning of your appointment.

Consider this…

If any difficult feelings have come to the surface from filling out this form, please take a deep breath and remember that you are safe. Consider going for a walk in nature or calling a trusted friend to share what has arisen. Offer yourself some appreciation for the courage to complete this form.