Individual Session Intake FormThanks for taking the time to share. I’m looking forward to learning more about you! Name * First Name Last Name Email * Phone * (###) ### #### Are you predominantly solutions oriented (i.e. you would like to gain an understanding of how to solve specific problems), or discovery oriented (you are mainly interested in gaining a deeper understanding of who you are)? * How do you feel about routine? Do you crave or resist it? * How do you feel about specific assignments? Do you like to have exercises to complete in order to gain understanding, or do you prefer to talk it out freestyle? * When digesting information, do you prefer to read or listen? * When digging deep into your feelings, memories, patterns of behaviour, do you prefer to write things out, talk things out, or process silently while moving (i.e. swimming, hiking, etc.)? * When adopting a new behaviour, do you tend to stick with it, stick with it for a time and then drop it, or not even really adopt it in the first place? * Have you worked with a therapist recently? Yes No Emotionally, I am struggling most with: * Professionally, I am struggling most with: * Physically, I am struggling most with: * I am most proud of myself when I: * The biggest compliment someone could give me is: * When I meditate, the thing I find the most difficult is: My main goal when I meditate is to: If I could press a button and release 5 things from my life without any consequences or judgement, they would be (feel free to choose specific people/situations, or more general emotional states): * The most important thing I would like to accomplish in working with Kyra is: * Please use this space to share anything else you'd like to add: Thank you!
