Sovereign Man Path Intake & Screening

Full Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

How did you hear about Sovereign Man / who referred you?

What's bringing you to the Sovereign Man path right now?

What is your hope, or what will be different in your life, at the end of the Sovereign Man container and path?

Do you currently have a therapist, integration specialist, life coach, counselor, or psychiatrist you're working with?

Are you currently taking any medication prescribed for a mental health condition?

In the past 12 months, have you been hospitalized for a mental health crisis, or attempted suicide?

Are you currently having thoughts of suicide or self-harm?

If you are in crisis right now, please call or text 988 (Suicide & Crisis Lifeline) or go to your nearest ER. This form is not monitored in real time.

Is there anything else about your mental health history, current living situation, or current safety that you think I should know before we talk?

The Sovereign Man 12-week containers can cost $5,000 to $10,000+. I also offer 1:1 private sessions to start off the Sovereign Man path. What is you current financial situation?

Even though I am a trained psychotherapist, the Sovereign Man path is coaching, not a replacement for therapy or medical/psychiatric care — it works best alongside that support, not instead of it. Do you understand and agree with this?

I understand that submitting this form does not guarantee acceptance into the program, and that Jesse may follow up personally, including about safety, before scheduling a call.

Sovereign Man Intake Screening

Contact Info

Your Story

Current Support System