Please complete this form before our first session. Your honest answers will help me understand where you are, what you want to change, and how I can best support you. Take your time and answer openly.
What brings you here right now, and what made you decide it is time for support?
What relationship pattern keeps repeating for you?
How do you usually respond when someone becomes distant, inconsistent, or emotionally unavailable?
What do you notice happening in your body when you feel rejected, ignored, or uncertain in a relationship?
What boundary is hardest for you to set or maintain, and what usually happens when you try?
By the end of this program, what do you want to feel, believe, or do differently?
What could get in the way of your commitment to this process, and what support would help you stay engaged?