In order to receive your initial session, I need some basic information. The more background details you provide, the faster I can support you in getting resolution. 

As a suggestion, while answering the questions below, you may want to type them separately then copy and paste into the designated place on this form. So if there is a technology glitch you don't lose your hard work writing the details.

As you answer these questions, make sure to scroll to the bottom as some of the question don't show on the page until you scroll.

All of this information is saved in an encrypted database. No part of your information is ever shared or sold. It is kept confidential between you and I.

Do not reveal any information I would be forced to share if I was subpoena'd by a court of law.

WARNING: If you miss or cancel this session in the last minute (Unless its a legitimate emergency) you will loose any future opportunity to get a free introduction.

Thank you.

When you are done completing the form, you will be take to a place to schedule our first session.

Please let me know if you have any questions by texting me at 970-317-0001.