Getting to know you...

Thank you for arriving here to explore working together.

The purpose of this questionnaire is to help me learn a little but more about you and your needs to determine if my style of mentorship will be a good fit for you.

Once you have completed the form, I will get in touch with you via email.

Full Name

Email

Where are you located? (City & Time Zone)

What initially drew you to private mentorship with me?

Have you worked with a mentor, coach, or therapist before? If so, what was your experience like?

How would you describe your current relationship with your body and self-trust?

Do you ever feel disconnected from your body, emotions, or inner knowing? If so, in what ways?

What are the biggest challenges or blocks you feel when it comes to embodiment, intimacy, or self-connection?

Do you ever feel resistance, shutdown, numbness, or hesitation in intimacy?

Are there any patterns in relationships (with yourself, others, or your body) that you feel stuck in?

What do you most deeply desire to experience in this mentorship? (Self-trust, deeper intimacy, softness, embodiment, pleasure, nervous system regulation, etc.)

What kind of support do you need most right now? (Space to be held? Practical tools? Gentle guidance? A mix?)

Which mentorship option are you interested in?

Attune – 3 Sessions

Deepen – 6 Months

Unsure, I need help deciding

Mentorship requires commitment, openness, and a willingness to explore your inner world. Are you ready and available to engage with this work at this time?

Yes

I'm not sure yet

Do you have any concerns, hesitations, or questions about mentorship that you’d like to share?

Is there anything else you’d like me to know about you before we begin?

I acknowledge the Turrbal and Yuggera Peoples, the Traditional Custodians of the land on which I live and work in Meanjin (Brisbane). I honour their deep connection to Country and pay my respects to their Elders past, present, and emerging, extending that respect to all First Nations peoples.

I also offer gratitude to the East—its people, cultures, and wisdom traditions—for the teachings that have shaped the embodiment practices I share. I recognise the custodial voices that have preserved these traditions and honour them with reverence and respect.