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Professional Mentorship Intake

Name

Pronouns

What are your goals for working together? What will your emotional, spiritual, physical, and professional life look like when we are done working together?

What brings you feelings of comfort, safety, and goodness?

What skills/qualities are you hoping to practice and develop through Mentorship?

What frameworks, theories, and modalities inform your work?

Please describe your educational and professional background.

What books (fiction and non-fiction) inform your understanding of your professional practice?

In what ways do you learn what you do not know? How do you explore your blindspots?

Describe your strengths in your practice? What would your clients say you do well?

What in the past has worked well for you when you have wanted to make a shift in your life?

Who are the most important people in your life right now?

Who are part of your support team (friends, therapists, medical professionals, etc)?

How do you spend most of your free time?

Your Email

Your Phone number

Who is your emergency contact (phone, email, address)?

How did you find me?