I’m so glad you’re here.

Ahead of meeting please let me know if there is anything you want to share. This space is for you. Whatever you feel like will benefit our conversation.

This form is not required prior to our session.

Take your time. We’ll begin where you are.

Name

First Name

Last Name

Email

Pronouns

Preferred way to connect

Tell me a bit about what brought you here.

Do you have any accessibility, processing, or communication preferences you’d like me to know?

Have you worked with a couch (professional or personal) in the past?

Yes

No

If yes, how did that experience feel for you? What worked? What didn’t?

Bridgework Intake Form

I’m so glad you’re here.