New Client Intake

Tell Me About Your Journey

This form helps me understand your needs. All information is kept strictly confidential.

Contact Information

First Name *

Last Name

Email *

Phone

What are your primary goals for this work? *

What challenges are you currently facing?

How urgent is this for you? *

Preferred contact method? *

Best time to contact you?

I have previously worked with a therapist, counsellor, or bodyworker

Anything else you'd like me to know?

I consent to My Pleasure Pathway storing my information securely for the purpose of providing services *

I agree to be contacted by Tracy Louise regarding my enquiry

Your information is stored securely and never shared.