Jani in a blue scarf — Let’s Connect

Please fill out the form below. Answer as honestly and spontaneously as possible. I acknowledge your courage and am excited to meet you!

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

What is your primary reason for seeking support?

When you think about what bothers you, what are the 3 main areas predominant in your thoughts?

When someone or something “pushes your buttons” how do you usually respond? (e.g. run, react, or resist)

If there was one thing in your Life you would like to change, what might that be? What about this would you like to change?

In the past week, what important issue have you procrastinated or avoided?

I do not have standing appointment times for Connection Sessions. Please provide me your best two days with the best time frame where you will have privacy, and wifi for Zoom or a good cell connection. I will reply shortly by email with a link to schedule our time together.