Intake Forms

Intake Form for Rapid Transformational Therapy Sessions

Thank you for booking your RTT session.

This form helps me understand your background, experiences, and the changes you would like to create so your session can be personalised and effective.

Please answer as openly as you feel comfortable.
All information is treated with care and confidentiality.

First name

Last name

Email

Phone

Address

Are you taking any medications?

Do you have Epilepsy, Bipolar or had any psychotic episodes?

What is the best time for an appointment with me? i.e. daytime, evenings, weekend

What is the reason you desire to have a Rapid Transformational Therapy session with me?

If I could wave a Magic Wand and you could get anything you wanted from this session, what ONE SPECIFIC OUTCOME would you like to receive from our session that would help you to move forward or make changes in your life?

What is currently holding you back or preventing you from achieving your goals or making the changes you need in your life? What holds you back from taking action to make the life you want? i.e. procrastination, fear, doubt, not feeling good enough

How do the above obstacles show up in your daily life? What are the SYMPTOMS you have - physical, emotional? i.e. fear, self doubt, addictions, anxiety, pain

What situations trigger that issue or concers?

What do you judge or criticise yourself for? Is there anything you hold guilt or shame about that holds you back?

Describe in as many details as you can what you would like life to look like if your magic wish was granted. What would you believe about yourself? What would you feel? What you have? What would you be doing or not doing? Be very detailed and specific.

What would you need to BECOME in order to achieve your life goals? i.e. courageous, safe, unstoppable. Give me YOUR words

What would the impact of this wish being granted have on your life? What will your life look like? How will it affect your relationships, finances, health, spirit?

Is there anything else you would like to tell me?

Chaos to Calm Intake Form

Thank you for taking this step toward reducing overwhelm and creating more calm in your daily life.

This short form helps me understand your current priorities, pressures, and the kind of support that will feel most helpful for you right now.

There are no right or wrong answers, and you don’t need to have everything figured out.
Simply share what feels true for you at this moment.