Feedback Form

I care about your experience and would love to hear from you about how our time together has impacted you. Your authentic feedback is how I learn and grow. I would love to hear from you…

Name

First Name

Last Name

What challenges or curiosities originally led you to seek out an experience with me?

How did you feel about the intake process and preparatory steps prior to our session? Did you feel adequately prepared for our session? Why or why not?

How did you feel during our session and in the aftermath of your experience?

Since our session, have you noticed any shifts on a mental, physical or emotional level??

Has our experience together created any kind of impact on your actions or behaviors?

Would you like to continue exploring together? If so, what would you like to focus on during our next experience? If not, how come?

Is there anything else you would have liked us to focus on during our experience, or that you hope we could explore together in future?

Do you have any unspoken feedback for me about how I can better support and nurture you?

Would you care to write a testimonial to share about your experience with others?

Would you like your testimonial to be anonymous?

Yes, do not include my name.

Please only use my first name.

You may use my full name!