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Full Name
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First Name
Last Name
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2
Email Address
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example@example.com
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Instagram Handle / Facebook Page / Personal or Business Website
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Instagram.com/yourname
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Phone Number
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Where are you in the world/What time zone are you in?
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6
Have you experienced a somatic approach to therapy or coaching before?
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Somatic Therapy
Coaching
Both
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7
What about my work prompted you to reach out? Was there a specific post, a theme, a feeling, an insight?
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8
What feels alive, tender, challenging, or ready to shift?
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9
If we did end up working 1:1 together and things unfolded beautifully… what would you hope would feel different for you in 6 -12 months?
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10
On a scale of 1-5, how ready do you feel to actively participate in your own growth right now?
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1 (not ready)
2
3
4
5 (100% ready)
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11
Reweaving Wholeness is a deeply transformative mentoring journey for women who are ready to come home to themselves. This work supports women to reconnect with their body wisdom, reclaim their inner authority, and create lives rooted in authenticity, nourishment, and alignment. Together we explore the intersection of embodiment, self-leadership, and spirituality—unravelling the patterns of over-functioning, self-abandonment, and social conditioning that keep us disconnected from our truth. At its heart, this work is about remembering your wholeness. It is about embracing both your softness and your fierceness, learning to trust your body’s intelligence, and cultivating a life that reflects who you truly are. What is your financial capacity and willingness to invest in this deep and transformative 1:1 mentoring journey over a 6–12 month period?
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$0 - $500
$500 - $1500
$1500 - $3000
$3000+
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12
Preferred method of contact
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Email
Text Message/Voicenotes
Private Message on Instagram or Facebook
I’d be keen for a face to face chat if possible (Zoom)
Other
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13
Thank you for taking the time to share yourself with me here. Based on your answers I will be in touch shortly with options for how I can support you. Is there anything else you’d like me to know?
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