Deep Core Intake Form


Hey there!

I know forms can be a hassle, but please take the time to fill this out to the best of your ability. It will really help you get the most out of our work together. Anything you share will be strictly confidential.



Name *
Are you taking any medication for mental health-related issues, if so please explain: *
Have you ever been diagnosed or treated for a serious psychological or mental health issue?
Have you experienced any sexual trauma? *
Have you sought professional therapy of any kind in regards to this?
Do you have epilepsy, seizures, serious mental health issues or severe asthma? *
Are you currently in a relationship?