CLEARITY Entegration™ (NSIP): Application Form

CLEARITY Entegration™

Thank you for your interest in the CLEARITY Entegration™: An 8-week Nervous System Integration Process (NSIP) to help you establish internal safety and capacity. This application helps ensure that this integration process is aligned with your current needs, capacity, and desires for change. Please answer honestly and thoughtfully.
Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
WhatsApp Number (if outside the USA)
Location/Time Zone*
Alignment + Readiness
What led you here? What’s currently feeling stuck or dysregulated in your life?*
What would feel like a meaningful shift or outcome for you after this work?*
Have you done any somatic, nervous system, or subconscious work before? If yes, please describe briefly.*
Why do you feel called to this work now?*
How do you typically respond to discomfort or resistance during inner work?*
Mental Health Information
Are you currently in therapy or under the care of a mental health provider?*
Have you been diagnosed by a professional with a mental health disorder?*
If you feel comfortable and safe, please share the diagnosis you were given.
This sensitive information will remain confidential and will only be used to help provide you with the best possible care when working together. Please note, I do not believe any mental health diagnoses is a representation of who you are nor defines you as sovereign human being.
Capacity + Commitment
This work requires consistent participation. Are you prepared to attend weekly 60-minute sessions, complete integration practices between sessions, and engage honestly with your nervous system and internal process?*
Based on what you understand about NSIP, how ready do you feel to begin this process at this time?*
Is there anything else you’d like me to know as I review your application?
Final Note:

This is a co-regulated, trauma-informed space. Your responses are confidential and held in care. You’ll receive a response within 2–3 business days regarding next steps.
Should be Empty:

CLEARITY Entegration™

Contact Information

Alignment + Readiness

Mental Health Information

Capacity + Commitment

Final Note: