Welcome to your consultation!

In preparation for your Dynamic Emotional Integration® consultation, please fill out and submit this questionnaire.

All of your information — here and in your DEI consultation — will remain confidential (see the full privacy disclosure below).

The information you provide here will help me understand your emotional strengths and challenges, the current social and emotional situations you’re dealing with, and the supportive resources you have in your life.

Your Questionnaire

  • As you answer these questions, treat them as a snapshot of your current situation, behavior, skills, challenges, and resources - so that we can focus clearly on your present-day situation. Thank you!
  • About Your Situation

  • About You

  • About Your Support System

  • About This Consultation



Privacy and Confidentiality Statement: Everything in your Dynamic Emotional Integration® consultation is private and will remain confidential between us. Your information will not be shared, and your contact information will not be used for any other purpose. However, if we work by phone, Skype, e-mail, or in any other electronic format, it is possible that our privacy could be breached accidentally as a result of technical issues in the transmission of data. It is also possible that our privacy could be breached intentionally through hacking or surveillance activities. I will not intentionally share your information with anyone, but there are privacy risks inherent in electronic communications that I want you to be aware of.