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New Client Intake Form

New Client Intake Form

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The below form is the first step to discovery, focus & self-healing. Enjoy & appreciate the journey!

Please fill out the following form with quick first thoughts only. Your first thought is the correct answer. Extensive description will be discussed during your consultation.


Do you currently suffer from any of the following? If so, please check the corresponding box:

Let’s take a moment to see what senses you relate to most so I can prepare the best session possible for you.

Please check off  the characteristics that relate to your behavior:



I’ve known Jodi for years and it has been through her process of healing others that has also encouraged me to step up for myself. She has inspired me to create better alternatives with deep introspection.
- Solymar Ball, Boulder, CO,
Jodi helped to eliminate various mental blockages which were disrupting the life within me. The result is that I am now a far more confident person, and have a much deeper self belief & self worth. Thanks so much Jodi!
- William D., Morristown, NJ,

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