Personal Sessions: Client Intake Form

Becca Williams, RDN

My ability to draw meaningful insights into your current well-being and ways to enhance it relies greatly on you responding thoughtfully and accurately to these questions.

When I can thoroughly evaluate all factors and address them comprehensively, it becomes the most effective way for me to support your emotional well-being.

Please rest assured that all information you share here will be kept in full and absolute confidentiality.

Important: Be sure to have this form completed and submitted at least 48 hours before we meet.

I’ll see you soon,
Becca

Schedule Your Session

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What challenges are you facing that are upsetting your life?*

How are these difficulties showing up in your life?*

What are you currently doing to address these issues/challenges?*

On a scale of 1-10 (10=VERY ready), how strong is your will and desire to apply yourself mentally, emotionally and physically to transform your life?*

Please enter a number from 1 to 10.

How familiar are you with cannabis plant medicine and/or psilocybin microdosing? Many of my clients appreciate using these plant medicines as tools in our work.*

Are you ready to move outside your comfort zone for the sake of your personal growth and healing? If so, why now?*

Name*

First Last

Phone Number (WhatsApp – Int'l Free Calls)*

Email*

How did you hear about Becca's work? Also, have you worked with her in the past? If so, when?*

Name

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