Intake form

Intake form

Help us serve you better

Name *

Email address *

What type of trauma or stress injury are you experiencing?

Please select at least one option.

PTSD

Grief

Loss

Emotional Trauma

Physical Trauma

How long have you been experiencing these symptoms?

Have you previously sought therapy or counseling for your issues?

If yes, please describe your experience.

What are your primary goals for coaching?

Please select at least one option.

Healing from trauma

Improving emotional well-being

Enhancing coping skills

Building resilience

Developing mindfulness practices

Are you currently taking any medications related to your mental health?

If yes, please list the medications.

What healing modalities are you open to exploring?

Please select at least one option.

Bodywork

Nature therapy

Crystal energy healing

Sound healing

Mindfulness practices

How did you hear about IntegralPTSD?

Do you have any specific concerns or questions you would like to address during your coaching?

Additional questions or comments

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IntegralPTSD

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