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I keep my practice small so I can show up fully. Join my waitlist—I'll reach out when there's space.

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A Little Bit About You

What kinds of somatic processing, meditative, or other kinds of embodied practices are you familiar with?

Questions?

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I keep my practice small so I can show up fully. Join my waitlist—I'll reach out when there's space.

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First Name

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Interests

1-on-1 Therapy (Online) Advanced Practices Group (Local)

A Little Bit About You

Questions?

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I agree to being contacted when space opens, and for receiving occasional emails in the newsletter. I can unsubscribe from the newsletter at anytime.

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Site Feedback Form

Client Feedback Form

Your thoughts mean a lot and will genuinely help me continue improving this work.

Your Experience Matters

Thank you for taking the time to share your feedback. Your honest thoughts help me improve my practice and can help others understand whether this work might be right for them.

Your feedback is completely confidential unless you explicitly give permission to share it publicly. If shared, your real name will not ever be made public.

How many sessions have we had together?

On a scale of 1-5, how would you rate your overall experience?

What's been most helpful about our work together?

What could be improved or done differently?

How well does the technology and platform work for you?

If you were describing our work to a friend considering therapy, what would you say?

On a scale of 1-5, how likely are you to recommend me, or the platform, to someone who might benefit?

Share Feedback

With your permission, I'd love to share your feedback to help others understand what this work is like. Please tick here if you are happy with me sharing your feedback anonymously.

Consent

I consent to for this information provided above to be stored on my file, accessible for myself and my therapist.

K10+ Assessment

Interest Form

Introduction

Help me get to know you a little. All material in this form is held in confidentiality.

First Name

Last Name

Please introduce yourself, and tell me a bit about your story. Feel free to write as much as you feel is appropriate and relevant.

Current Context

Help me get an idea of where we'll be starting from.

This inquiry is focused guiding for seeing there is no real, inherent 'self'. What do you understand by this?

What do you think waking up / spiritual awakening is about?

What are you looking for in this work?

What do you expect from guided conversations?

What is your experience in terms of spiritual experiences, spiritual practices, psychology/therapy, somatic practices, seeking and inquiry?

On a scale from 1 to 10, how willing are you to question any currently held beliefs about 'self'?

Medical & Support Information

Your welfare is important to me. Please answer these questions as honestly as possible.

What, if any, psychiatric or mental health related conditions or concerns do you currently have?

What, if any, medications (legal or otherwise) do you currently take that might be relevant to your psychological condition?

Do you have any known history of trauma that you feel may be unprocessed?

Yes No

How is your physical health at this time? Do you have any concerns?

What, if any, kind of medical or psychological oversight do you currently have, or could readily get access to?

What does your support network look like? This can include partners, friends, interest groups, family, or any other form of community.

What kind of healthy and supportive activities do you currently engage in? This can include hobbies, physical activities or exercises, mental activities or exercises, or anything else that supports your wellbeing.

Are you reasonably financial stable at this time with the capacity to endure a period of unexpected instability?

Yes No

Research Use

Would you be open to allowing our exchange - your data - to be anonymously used for potential future scientific research work related to this process?

Research Consent (Optional):

Yes, I agree to the anonymous use of my data for potential future research as related to this process. I understand I can provide a written request to withdraw my research consent at any time. I understand that doing so will not retroactively remove my data from any research already published.

Disclaimer

Engagement through Waking Alive involves instructions on how to see through the self-illusion, and may include text and video contact. It is recommended not to engage with this process if you are mentally or emotionally fragile and cannot live a normal life, and/or have to take psychiatric medication or self-medicate with substances. During this process, deep shifts of perspective can happen that could be destabilising and pull the rug from under you - get better first, then you can re-consider embarking safely on this journey. The dialogue with me is not a substitute for medical or psychological treatment.

Consent

I have read, understand, and accept the disclaimer above, and agree to take full and total responsibility for my wilful engagement with this process, and for any seen or unforeseen repercussions. I also agree to the privacy policy and terms & conditions linked below.

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Your Experience Matters

Your Experience Matters

Your K10+ Score

Introduction

Current Context

Medical & Support Information

Research Use

Disclaimer