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Begin Your Story Work Journey

A few reflections before your free consultation — Reclaiming Shalom

Thank you for reaching out. This form helps me get to know a little of your story before we meet, so our consultation can be as meaningful as possible. Take your time, and share only what feels right for now. Fields marked * are required; everything else is optional.

If you are in crisis, please don't wait for this form. Story coaching is not emergency or crisis care. If you are in immediate danger or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline, U.S.) or call 911. You matter, and help is available right now.

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About You

First name *

Please enter your first name.

Last name *

Please enter your last name.

Preferred name What would you like me to call you?

Email *

Please enter a valid email address.

Phone

Best way to reach you

Email

Phone call

Text message

Where You Are

City & State/Province *

Please share your general location.

Country

Your time zone *

Please select your time zone.

Age range

When are you generally available to meet? Days and times of day that tend to work for you. Sessions are held by video.

Are you comfortable meeting by video call? *

Yes

I'd like to talk about it first

Please choose one.

Why Story Work

What draws you to story work right now? * There's no wrong answer. Share as much or as little as you'd like.

Please share a little about what brings you here.

What are you hoping for as you begin? What would healing, growth, or change look like for you?

Why now? What's prompting you to reach out at this point?

How familiar are you with story work / narrative-focused trauma care?

Your Background & Experience

Have you worked with a counselor, therapist, or coach before?

Yes

No

If yes, what was that like — and what did or didn't help?

Are you currently working with a therapist or counselor? Story coaching can sit alongside licensed care; it doesn't replace it.

Yes

No

Faith or spiritual background My work is grounded in a biblical framework. Sharing where you are helps me meet you well — wherever that is.

How do you feel about working within a faith-based / biblical framework?

What You're Carrying

What's present in your life right now that you'd like support with? Only share what feels comfortable. We'll go deeper together, at your pace.

Are any of these themes part of your story? (optional — check any that fit)

Grief or loss

Childhood wounds / family of origin

Sexual abuse

Sexualization in childhood

Physical, emotional, or verbal abuse

Spiritual abuse or church hurt

Betrayal or broken trust

Neglect or abandonment

Relationships or marriage

Sexuality & intimacy

Addiction or compulsive behaviors

Identity & self-worth

Anxiety, depression, or shame

Faith questions or spiritual struggle

Life transition or direction

Something else / not sure yet

Before We Meet

What would make this consultation feel worthwhile for you?

How did you hear about Reclaiming Shalom?

Anything else you'd like me to know?

A Few Acknowledgements

About this work: Reclaiming Shalom offers story coaching, a faith-based approach to understanding and healing through your personal story. It is not licensed psychotherapy, medical care, or a substitute for treatment of a mental health condition.

I understand that story coaching is not therapy, medical, or emergency care. *

I consent to Reclaiming Shalom contacting me using the information above to schedule a consultation. *

Please check both boxes to continue.

Your responses are private and used only to prepare for your consultation.

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