Part A
About You
Have you worked with Shae before, or are you a new client? *
If new, please briefly describe your current therapeutic relationship (e.g., currently in weekly therapy, not currently in therapy, etc.).
What brings you to a therapy intensive at this time? *
What is happening in your life, or within you, that makes this feel important right now?
Briefly describe what you most want to shift, resolve, or experience by the end of your intensive.
How would you describe your current emotional and nervous system baseline on most days? *
e.g., generally regulated, often anxious, frequently shut down or numb, oscillating, etc.
Part B
Clinical History
Have you engaged in trauma therapy before? *
If so, what modalities (e.g., talk therapy, EMDR, somatic, IFS) and for how long?
Do you have any history of dissociation, depersonalization, or significant disconnection from your body? *
If yes, is this something you are actively working on with a provider?
Are you currently working with any other mental health providers? *
If so, please share their name and role so we can coordinate care if needed.
Are you currently taking any psychiatric medications? *
No details required — just a yes or no to help with clinical planning.
Select one…
Yes
No
Have you been hospitalized for mental health reasons in the last 12 months? *
Select one…
Yes
No
Do you have any current concerns about safety — including thoughts of self-harm or suicide? *
Please be honest; this helps ensure we create the right container for your work.
Part C
Logistics & Preferences
Which intensive package are you most drawn to? *
Select one…
Root & Reset — Half-Day (4–5 hrs) · $875
Reclaim & Restore — Full-Day (7–8 hrs) · $1,700
The Deep Return — 1.5–2 Days (10–14 hrs) · $3,200
Not sure yet — help me decide
What draws you to that package? *
Do you have a preference for location format? *
Select one…
At The Healing Spot (Shae's office)
Private venue (off-site · client covers rental)
Not sure yet — tell me more
Are you interested in the Full Care add-on? *
Meals, nourishment, and comfort provisions handled entirely by Shae.
Select one…
Yes
No
Tell me more
Are you interested in adding a sound bath to your intensive? *
Crystal-bowl sound bath for nervous system regulation. Included with The Deep Return.
Select one…
Yes, please add it
No, thank you
Already included (Deep Return)
Tell me more
Have you ever done intentional breathwork before? *
e.g., holotropic, conscious connected breath, or guided breathwork. If so, what was that experience like for you?
Do you have any dietary restrictions or preferences Shae should know about? *
Relevant for Full Care and break nourishment.
Are there any physical considerations that should inform how the space is set up or how the day is structured? *
Mobility, pain, sensory sensitivities, etc.
Is there anything else you'd like Shae to know before your consultation call?
