Exploring Fit with Jenn Kerns — Initial Inquiry Form

Exploring Fit with Jenn Kerns — Initial Inquiry Form

A brief set of questions to help determine whether my approach and scope of work align with what you’re seeking before scheduling a first conversation. Please set aside approximately 10–15 minutes to complete this form.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Best days/times to call you?
Do I have your permission to leave a voice message on number above re: coordinate a clarity call? If NO, how can I best coordinate scheduling a call together?
Hello! Thank you for reaching out to explore working together. I work with people who resonate with my integrative, contemplative, and neuroscience-informed approach, with a focus on post-traumatic growth and conscious transformation.This short inquiry form helps us explore whether working together may be a good mutual fit. Please note that I am not offering crisis stabilization or active trauma processing. If you are currently in acute distress, I encourage you to seek immediate local support — and I’m always happy to provide referrals.
Yes, thoroughlySomewhatNot yet (I will before proceeding)No
2.) In a few sentences, what’s motivating you to reach out at this point in your life? What are you hoping to explore, strengthen, or transform?
YesPossibly — I’d like to learn moreNo — I may need a different level of care right now
NoYes — in the past, but not currently activeYes — currently activePrefer not to answer at this time
If yes (past or current), please briefly describe:
If active: Are you engaged in treatment or recovery support? Please briefly describe:
Please note: My practice does not provide treatment for active substance dependence. This question helps determine clinical fit and appropriate referrals when needed.
NoYes — in the pastYes — currentlyPrefer not to answer
If yes, please share when and in what context (optional):
6.) I work with creative, spiritually curious, and deeply motivated individuals who are already “doing the work,” however feel called to stretch beyond comfort zones, and commit to sustained growth and self-mastery. How does this description resonate with you?
NoYes — passive thoughts (e.g., wishing I wouldn’t wake up)Yes — active thoughtsPrefer not to answer
NoYesPrefer not to answer
If yes, you may briefly describe (optional):
If you are currently in immediate danger, please call 911 or go to your nearest emergency department. If you are in Vermont, you may also contact the Howard Center Crisis Line at 802-488-6400. These questions are included only to help determine whether my services are the right fit for you at this time.
8.) I operate on a tiered private-pay model for self-pay. For insurance, I only bill insurance Green Mountain Care (Medicaid). That means, for folks who do not have Medicaid (VT), I am out-of-pocket first; it is up to you to see if your insurance reimburses for "out-of-network" providers (I can provide superbills for you to submit). For self-pay, my current fee schedule and accessibility options are listed on my website under "For Clients: Financial Self-Assessment Guide." Are you prepared to engage in out-of-pocket payment at this time?

YesPossibly — I have questionsNo
(Optional) What insurance plan do you currently carry?
Would you like to be considered for one of my weekly "Pay What You Can" sessions, for those experiencing extreme financial hardship (i.e. homelessness, bankruptcy, fleeing abuse, disability etc)? Tell me more, as much as you feel comfortable. No judgement zone.
PsychotherapyProfessional Consultation / Peer SupersivionEducational “Ask Me Anything” ConsultationSpiritual CounselingGrief CounselingPost-traumatic growth / integration Inner WorkIntegrative Medicine Mental Health Assessment /ConsultationSmall Business ConsultationOngoing workNot sure yetOther
Anything else you’d like me to know as I consider whether we might be a good mutual fit?
How did you hear about me?
Thank you for taking the time to complete this inquiry. I really appreciate it.

I personally review each submission thoughtfully, and will reach out if I feel there may be a strong mutual fit for working together at this time.

Due to the volume of requests I receive, I’m not able to respond to every inquiry.

If you do not hear from me, please know I’m wishing you well in finding the right support for your journey.

With gratitude,

Jennifer L. Kerns
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