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New Client Intake Form

The Shift Series Intake Form

Before we meet, take a few minutes to fill this out. This form gives me a sense of what’s going on, what’s weighing on you, and what kind of support will be most useful in our time together. There’s no need to overthink or write perfect answers—just be honest. This is a space for truth, not performance. Everything you share is confidential. You’ll receive a link to schedule and pay for your session after you submit.

Name(Required)
Preferred method outside of our appointment/meeting time
What feels off, stuck, or unclear? No need to polish it up, just say what’s real.
Have you worked with a coach, therapist, or mentor before?(Required)
If yes, please provide details
Clarity, energy, boundaries, career, relationships—name what matters most to you.
Think beyond survival—what do you actually want to feel or experience?
How would you like to meet?(Required)
Access needs, learning styles, neurodiversity, sensitivities, etc.
This can be personal, practical, or completely unexpected.
Equity Based Pricing: Choose Your Tier(Required)
I run on a tiered, honor-system model, no documentation, no judgment. Pick the tier that fits your annual household income right now. Why I ask: This tells me which rate to invoice you and helps keep the whole model sustainable. Your honesty keeps the doors open for everyone. You will receive a link to schedule and pay after your Intake Form has been reviewed. Don't worry, it won't be too long of a wait!
Agreement:(Required)
Consent(Required)

Say The Thing You’ve Been Holding Back

You don’t have to know exactly what to say. Just start here.