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Welcome to Chrysalis: a private & customized transformation experience!
To better help you, please start by answering the following questions to the best of your ability
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1
What can I call you?
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Your Name
Your Pronouns
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2
What is your E-mail address?
example@example.com
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3
What drew you to this experience?
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4
Many people come to this space to work on the following themes. Please select as many as relate to you even if they aren't the focus of this experience together:
Religious trauma issues
Sexual trauma issues
Childhood trauma issues
Family trauma issues
Communication and self-expression blockages
Alcoholism or drug addiction
Intimacy Issues
Sexual Orientation or Gender Identity
Parenting Issues (As a parent)
Relationship Issues and Dynamics (past or present)
Suicidal thoughts and ideations
Life-transition Issues (job loss, aging, career changes, living arrangement changes)
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5
If you had a magic wand to change two or three things in your life, what and how would it change?
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6
Have you/are you currently working with a mental health professional?
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7
How will you know our work together was successful?
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8
Is there anything else you think I need to know?
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