Unbound Application

Thank you for your interest in working with me. This application helps me understand what support would be the best fit for you.

Please answer honestly. There are no right or wrong answers.

Basic Information

First name

Last name

Email

Phone

Which are you interested in? (check all that apply)

The Unbinding Therapy Intensive

Reignite 6-Month 1:1 Coaching

Gremlins & Goats Mini-Course

Something Else

What feels hardest in your life right now?

Which best describes you right now?

I feel stuck and overwhelmed

I’m functioning but exhausted

I’m ready for deep personal change

I’ve done therapy and want something more immersive

What have you already tried to feel better?

Why does now feel like the right time to seek support?

Are you able to invest in your healing right now?

Yes

Possibly, depending on options

Not at this time

Anything else you’d like me to know?