Intake — by application

Before we sit together, I'd like to know who's arriving.

Ten questions, in your own words. There's no length expectation — speak as you would across the desk. Your responses are saved as you go, so you can return when it's right.

Take your time. The form will hold its place for you.

First and last name

Email

Phone

Once you click Begin, your responses save automatically as you go. You can close the tab and return through the link in your URL bar.

If you're in immediate distress, please call or text 988 (Suicide & Crisis Lifeline). Hypnotherapy isn't an emergency service.

Step 01 · Discovery

How did you come across me, and what specifically made you reach out today?

Speak as you would across the desk. There is no length expectation — long answers are welcome, one careful sentence is also fine.

Step 02 · The Issue

What's the issue or pattern you're working through, and what's it like to live with day-to-day?

Tell me the texture of it, not just the label. The way it shows up on a Tuesday afternoon.

Step 03 · Origin

When did this first show up in your life? What was happening then?

If you remember the first time, name it. If it feels like it's always been there, say that.

Step 04 · A Recent Moment

Walk me through a recent moment when this pattern showed up — what happened, what was going on inside?

Specific is more useful than general. One actual moment, in order, with what you noticed in your body and mind.

Step 05 · What You've Tried

What have you tried before to address this, and what made it fall short for you?

Therapy, coaching, plant medicine, books, breathwork — whatever it was. Honest answers help me meet you where you actually are.

Step 06 · The Stakes

If nothing changes and this continues for the next 1–3 years, what does life look like?

It's worth letting yourself imagine it, even if it's uncomfortable.

Step 07 · The Vision

If you woke up six months from now and this was fully resolved, what would be different — in your day, your relationships, your inner world?

Be as specific as you can. The clearer this is, the more useful it becomes inside session.

Step 08 · The Burning Question

If you could ask one question and get a real, honest answer, what would you ask?

Ask the question itself, not a description of the kind of question.

Step 09 · Health & Safety

Anything about your physical or mental health, medications, current therapy, or relevant history I should know?

Conditions, diagnoses, medications, a current therapist — anything that helps me work with you safely. Brief is fine.

Step 10 · Anything Else

Anything else you'd like me to know — including anything you're hesitant to share but want me to have?

The thing you almost didn't write. This is a good place for it.

Sending

Holding your responses

Received

Thank you. Your responses are received.

I'll read every word before our first conversation. You'll hear from me within two business days.

Take a breath. The form did its part.