Name *

You're welcome to use your chosen/preferred name here.

First Name

Last Name

Date of birth *

Please note I only work with people over the age of 18

MM

DD

YYYY

Phone *

Don't worry, you won't recieve any unexpected phone calls.

(###)

###

####

Availability - What times are you most likely to be available for appointments? *

Please select all that apply

Wednesdays 1pm - 4pm

Wednesdays 4:30pm - 6:30pm

Thursdays 8am - 11am

Thursdays 11:30am - 1:30pm

*

These are my preferences but I am flexible

I am only available within these times

I have more specific restricted availability within these times:

How often would you like to have appointments? *

Please let me know your preference - this helps me make sure I have enough available appointments when I first book you in. There is flexibility to change once we've discussed this in our first appointment, and ongoing if we continue to work together. People usually start with fortnightly appointments (every 2 weeks).

Weekly (every 1 week)

Fortnightly (every 2 weeks)

Monthy (every 4 weeks)

Would you like to opt out of recieving a phone call when appointments are available?

Yes - email and text only

Would you like to schedule a 15 minute intro call before joining the waitlist?

Yes