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Are We a Good Fit for 1:1's?

Welcome friend! Let’s Find Out!!

- Thanks for your interest. This short form helps us both make sure we’re a good match. Just a few quick questions so I know if I can help.

- I work best with people who are ready to grow, curious about change, and committed to the baby steps.

- If you sign up to meet with me, I'll be in your corner 100% of the way.
- And the process with me is simple and straightforward.

Your full name:

Your state of residence:

Your email address (no spam):

Your phone (no spam):

How did you hear about Katharine?

How did you hear about Katharine?
A
B
C
D
E
F
G

You understand that Katharine can provide counseling to residents of Idaho and Texas, but if you reside outside of those states, you are signing up for coaching:

You understand that Katharine can provide counseling to residents of Idaho and Texas, but if you reside outside of those states, you are signing up for coaching:
A
B

You understand Katharine works only with individual adults:

You understand Katharine works only with individual adults:
A
B

Katharine's session window is Tues-Fri, 9am MST to 3pm MST. Can you make this window work to meet for 1 hr every week?

Katharine's session window is Tues-Fri, 9am MST to 3pm MST. Can you make this window work to meet for 1 hr every week?
A
B

Please indicate the ideal day and time for your sessions (within Tues-Fri, 9am-3pm MST:)

You are seeking treatment for Eating Disorders, Erectile Dysfunction and/or ADHD?

You are seeking treatment for Eating Disorders, Erectile Dysfunction and/or ADHD?
A
B
C
D

(Katharine only accepts insurance for video counseling.) You would like to set up regular video sessions:

(Katharine only accepts insurance for video counseling.) You would like to set up regular video sessions:
A
B
C

You understand Katharine's rate for in-office sessions is $189 self-pay only, paid in advance to secure your appointment:

You understand Katharine's rate for in-office sessions is $189 self-pay only, paid in advance to secure your appointment:
A
B
C

If you'd like to use insurance for video sessions, please indicate your insurance carrier, and if you feel comfortable, your policy numbers so I can check your benefits and copay:

What would you like to discuss in meetings with me? (Even a vague idea is okay:)

How would things look a month from now if you felt more in control of your situation? What would be different...?