Full Name
*
First Name
Last Name
What are your preferred pronouns?
Email
*
Phone
(###)
###
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Which Journey Bundle are you applying for?
*
Mind Body Immersion
Emotional Alchemy
Soul Story Repatterning
What draws you toward this work right now?
(A few sentences about what you're navigating or seeking support for.)
Have you worked with me before?
Yes/No, if yes, in what capacity (Optional: Note anything that felt especially supportive.)
What area(s) of your life feel like they need the most tending?
Are you able to commit to regular session times and self-reflection practices between sessions?
Are you able to commit to regular session times and self-reflection practices between sessions?
Any health conditions, medications, or energetic considerations you’d like to share?
Is there anything else you'd like Nicole to know about your intention, readiness, or background?
ONLY FOR Mind Body Immersion
Are you currently navigating a major life transition? If so, describe briefly.
ONLY FOR Soul Story Repatterning
Are you familiar with shadow work, ancestral healing, or archetypal self-inquiry? What feels exciting—or intimidating—about this?
ONLY FOR Emotional Alchemy
What emotions or inner patterns feel stuck, overwhelming, or hard to name right now—and how have you previously helped yourself feel in a more balanced way?
