Name *

First Name

Last Name

Have you worked with alternative, naturopathic or holistic practitioners before? *

Yes, one or a few.

No, but I'm open and ready for a new approach. I understand this will be a very different experience from a standard medical approach or even a standard functional/naturopathic approach.

No. Only standard medical practitioners. I'm most comfortable with this approach.

All sessions are online. Comfort with technology as well as possession of a personal computer or smart phone is required. Will it be a breeze for us to partner? *

Yes. I am very comfortable with tech, have the devices, and the ability to meet virtually.

No, I will choose to find a practitioner that provides in-person support.

All lab testing and supplementation are a separate cost. Supplements and labs will not be covered by insurance. Is this a good fit for you? *

Each lab test can range from $200 to $500 and supplements often start around $500/month.

Yes. I can pay out-of-pocket to work with you.

No. I need to use insurance to cover my costs, so I will look into partnering with another practitioner or return when I feel financially ready.

Are you willing and ready to take ownership for what your naturally sensitive self needs? Are you ready to change your lifestyle, your boundaries, your communication, your schedule and your expectations of life? *

Yes, I have been trying to live this on my own and it's challenging! I can't wait to do it with you as my mentor, to feel less alone in the journey and to gain short cuts and wisdom from your experience.

Yes. I am a bit nervous, yet I know it's time. I am very ready, especially with you by my side.

No, this feels like too much in this season. I'm going to wait till I am ready to make these big changes.

In our partnership, you will invest your time, energy, emotions, thoughts, and money in new ways that prioritize the highest value – your complete health. Are you ready for this? *

Yes! I feel like I already do this regularly, but I'm missing something or want to take it deeper and I can't wait to identify this with you!

Yes, yes, yes. I'm so ready for this. I cannot wait to begin the process and come out the other side my truest self! Thank you for giving me this opportunity to show myself how truly worthy I am of all my resources!

Yes, I'm ready, but a little nervous. I've never dived this deep and the unknown feels a bit scary, but at the same time I want the results and I am ready to put in the investment to get there.

No. I can feel that I'm not ready to fully prioritize myself. I sense resistance in me that I'm not in the season to navigate. I know I'm always welcome back when I'm ready.

Scheduling Agreement *

If approved, I understand that each client spot has a specific time slot that I will agree to for the entirety of our 6 months together. For example, every other Wednesday at 11 AM PST. I understand I have the option of rescheduling one session for whatever reason is needed. This session will be added to the end of my time with Jess, extending it by 2 weeks and scheduled at the agreed-upon package time. After this one grace session, I understand I will simply lose the session if I cancel. I understand these spots are very limited. I also understand that Jess holds the same option and will always do her best to communicate as early as possible if a reschedule need arises on her end.

Through our biweekly sessions, we will not only ease your present symptoms but uncover and identify any inauthenticity in your day-to-day, internal talk, and perspective on life. This depth of work requires an openness and level of vulnerability that requires trust. Are you ready to trust me with your inner most self? *

Yes, absolutely. I've been following you and I've possibly even already moved through the Method. I feel so understood and safe with you already. I can't wait to meet with you privately!

Yes, I am familiar with you. I'm still a bit nervous. Most therapists, doctors or mentors have not really understood how I felt. My heart may not fully settle until we start.

No, I'm not ready to dive into my emotions or thought patterns. I want to focus soley on my body's symptoms. I will choose to work with another practitioner for now.

Do you believe you will experience healing through our partnership? *

Yes

No

Select the number that best represents how committed you are to doing whatever it takes to restore yourself. Scale from 1 - 5, with #5 = I'm 110% Here For This and #1 = Not Very Willing. *

5

4

3

2

1

Considering the above questions, please select the statement that aligns. *

I answered yes to all of the questions. I rated 4-5 on the commitment scale. I’ve thoroughly read the requirements, am ready to commit to honoring my natural sensitivity, and understand your approach. I feel confident you’re the guide for me!

I answered yes to most of the questions, BUT I still feel uncertain about the commitment level. I will trust my intuition and wait for now. When I feel fully ready to step into deeper work, I will reach out and again. I know you'll be excited to help me!

I answered no to most of the questions, so I will be looking elsewhere for the support that is best for me.