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book a session & new client details

Book and pre-pay your session on the button below. Sessions are $100AUD for one hour.
Unfortunately my practice does not offer Medicare rebates.

Book now

If you are a new client, please fill this form out before booking your session. It will take around 15-20 minutes of your time and will help shape a picture of your holistic needs and goals.

New Client Form

Contact Details

* Indicates required field

Full Name *

First

Last

Phone *

Email *

Date of Birth *

Emergency Contact Name & Phone *

Main Occupation *

History

Main reason for contact, presenting issues *

All past surgeries, major illnesses & accidents *

Current and past medication, supplements or drugs *

Any significant family history of mental or physical disease *

Any relevant life history that you feel may be impacting your current health *

(For women) Frequency of menstruation, any significant pain, discomfort, moods, symptoms or patterns related to cycle *

Current self care (exercise, diet, spiritual practices, therapies) *

Current state of emotional health (quality & patterns of moods, significant stress, etc) *

Current state of sexual & reproductive health *

Describe your energy levels - be honest *

Quality of sleep (check all that apply) *

Very poor Irregular Average Oversleep /fatigued slee Good/ Regular Wake up tired frequently

Current quality of digestion (check all that apply) *

Regular Painful Bloating Constipation Loose/ urgency

Bonus round: What is something that's really important to you? *

Outcomes: how would you like to feel after a session? *

Submit

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valeria
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