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Private 1:1 Consultation Session Questionnaire

My goal is to support you and your loved ones through this process with compassion, clarity, and guidance. Please complete the questionnaire below so we can determine how best to meet your needs. I personally review every application to ensure our time together will be focused, meaningful, and supportive.

 

How It Works:

  1. Apply for a Session

    • Please fill out the short questionnaire below. This helps me understand your needs and ensures we can use our time together most effectively.

  2. Schedule Your Session

    • Once your questionnaire is reviewed, I’ll reach out to confirm your booking and provide details for your 60-minute session.

  3. Receive Support

    • Our session will be tailored to your situation—covering emotional support, guidance, practical tools, or planning, depending on your needs.

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Question 1 of 11

Full Name:

Question 2 of 11

Email & Phone Number

Question 3 of 11

Who is this session for? (Self/Loved one/Both) and will there be anyone else joining our call? Please list names and relationships to each other.

Question 4 of 11

In just a few sentences, please give a little background information. If you are aware of the following please include:

- The diagnosis of the illness/disease

- When was this diagnosis given? (Estimate is fine)

- If on hospice/palliative care, when did this start?

- How do you feel things are currently health-wise?

Question 5 of 11

Briefly describe your current situation or what prompted you to reach out.

Question 6 of 11

What are your main goals or needs for our session?

Question 7 of 11

Are there any urgent concerns or questions you want addressed?

Question 8 of 11

Katie offers 60-minute sessions for $250. Are you able to commit to the $250/session fee? (Yes/No)

Question 9 of 11

What are your preferred days/times/time zone for our session?

Question 10 of 11

Is there anything else you’d like me to know before we meet?

Question 11 of 11

Please let us know how you found us:

Confirm and Submit