The Spiral Intake FormAre you ready to transform your life? Fill out some info and I’ll be in touch shortly! Name * First Name Last Name Email * Phone (###) ### #### Why do you want to go through the Spiral? Why is now a perfect time to make a change in your life? What are your three biggest challenges or problems you are facing? What area of your life do you most want to transform/improve? What would be an outstanding tangible outcome for you as a result of doing this program? Do you have any mental health issues (significant past trauma or abuse, dissociative conditions, eating disorder, substance abuse, suicidal thoughts etc.)? If so, please provide details: Are you taking any prescribed and/or mind-altering medication? If so, please provide details: Thank you!
