Nervous System Integration Process: Application Form

CLEARITY Method™ Nervous System Integration Process

Thank you for your interest in the CLEARITY Method™ Nervous System Integration Process. 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
The Nervous System Integration Process is designed to be completed in sequence. All participants begin in Pathway 1 before moving into later pathways. Pathway 1 focuses on building safety, stability, and internal resourcing within the nervous system. These foundations are what allow deeper healing, integration, and pattern resolution to occur later without overwhelm or retraumatization.*

I understand that I must begin in Pathway 1 and that progression into later pathways occurs only after sufficient safety and resourcing have been established.
Before beginning the Nervous System Integration Process, all participants complete a 90-minute Nervous System Assessment. This assessment is a required first step and is not counted toward your integration session total. The purpose of this assessment is to understand how your nervous system responds to stress, safety, and connection so the work can begin in the right place and at the right pace.*

I understand that the first session is a required 90-minute Nervous System Assessment and does not count as an integration session.
This work requires consistent participation. Are you prepared to attend weekly or bi-weekly 60-minute sessions, complete integration practices between sessions, and engage honestly with your nervous system and internal process?*
If accepted into NSIP, which payment option best reflects your intended commitment at this time?*
Would you like to request a brief 15-minute guidance call to confirm fit and readiness before moving forward?*
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 Method™ Nervous System Integration Process

Contact Information

Alignment + Readiness

Mental Health Information

Capacity + Commitment

Final Note: