Please fill out the form below to schedule a complementary consultation call. If you don’t hear back from me within a week, my book is full and I’ve added you onto my waitlist. Name * First Name Last Name Phone * (###) ### #### Email * Location (City/State/Country) * What do you do for work? * How did you hear about me? * What services are you interested in? * Psychedelic Somatic Therapy ($250/hour) Somatic Experiencing Therapy ($250/hour) PSIP Intensive (only for students/therapists in PSI training or clients that have received PSIP from a previous practitioner) PSIP Supervision ($200/hour) Help me understand a little more about your medical history. Check all that applies to you. * I have a personal history of schizophrenia or psychosis I am actively struggling with significant and serious substance abuse issues I am pregnant or there is a possibility that I'm pregnant I have uncontrolled hypertension I have experienced acute suicidality within the past 6 months I had a recent severe head injury that is unstable None of the above applies to me Are you on any medications currently or within the past six months? * Have you received any diagnoses? * Why are you seeking support? * What is going well in your life? * Please describe the type of relationship you currently have. Are there people in your life you can go to for support? Do you have a sense of community? * Please describe any routines/activities/practices you have in place for physical & mental well-being. * You have been added to my waitlist :) I will reach out to you once I have availability. Thank you!
