Institute For Trauma - Exploration Call
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What type of trauma recovery/ nervous system regulation topics are you MOST interested in receiving support around?Type a question
*
Business education/coaching
Personal (relationships, parenting, career) support/coaching
General Trauma/Nervous System Education
1:1 Business Consulting with Dr. Lee
Something else - Please describe next
Something Else -
Are you interested in any other areas of support/education? (select all that you desire)
*
Business education/coaching
Personal (relationships, parenting, career) support/coaching
Professional Certification/Continuing Education
General Trauma/Nervous System Education
1:1 Business Consulting with Dr. Lee
What is your financial investment capacity? (Note, payment plans are available for all of our programs over $100)
*
Free
Up to $100 Total
Up to $100 Monthly
Between $100-$500 Monthly
Between $500-$1000 Monthly
Not sure/prefer not to disclose
What length of time commitment are you open to making? (select all that apply)
*
I’m interested in more short & sweet trainings (a few hours total)
I’m interested in a multi-week programs (1-12 weeks)
I’m interested in a longer term program (3- 12+ months)
I’m not sure!
Invitation to share a few sentences about the ONE thing you would like to address during our call
If you answered Business Education/Coaching in Question 1 please fill out these option questions:
What is your current work status?
Employed part time (less than 32 hours/week) by someone else
Employed full time (32+ hours/week) by someone else
Work part time in my own business
Work full time in my own business
I am not currently employed
Other (please describe in the next question)
Other Response:
Can you tell us a bit about your work?
Which of the following describes your previous business experience?
I've never started/ran a business of my own before
I've supported someone else in starting/running their business
I used to run a business and currently do not.
I currently run my own business
What, if any, other business programs or resources have you tried?
If everything went *perfect* over the next 12 months, what would your business look like? What do you dream of attaining/achieving?
If you answered Personal Support/Coaching (relationships, parenting, career) in Question 1 please fill out these option questions:
Have you tried other forms of recovery/regulation resources? If so, what have you previously tried? (select all that apply)
Somatic therapy (EMDR, Breathwork, etc)
“Talk” therapy (CBT, DBT, Couples counseling)
Yoga/ Movement practices
Plant medicine/psychedelic therapies
Prescription medications
Other (please specify)
Prefer not to disclose
Other Response:
If you answered General Trauma/Nervous System Education in Question 1 please fill out these option questions:
What is your Profession?
What types of training are you specifically seeking?
Do you desire CE credits? (We do offer specific programs that may meet organizational and ANA/AMA requirements)
If you answered 1:1 Business Consulting with Dr. Lee in Question 1 please fill out these option questions:
Dr. Lee’s 1:1 consulting for organizations and business owners/professionals requires a paid consultation call prior to engaging in more long term work. Her rate is $1000 for a 90-minute consultation, during which she will help you come up with a “best next steps” plan for your specific issue and discuss options for further support, if desired.
Would you like her assistant to contact you with further details? If so, please share your preferred contact method below.
I’m ready for a booking link, please email me at the email listed above
I’m ready for a booking link, please text me at the phone number listed above
I’m not sure if I’m interested, please email me at the email listed above to discuss further
I’m not sure if I’m interested, please text me at the phone number listed above to discuss further
No, I’m not interested - please share free/low cost resources of Dr. Lee’s instead.
Thank you for taking time to submit this form and we look forward to getting to know you more at ITRR! Next steps check your email in the next 48 business hours for an email from us!
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