Individual Therapy - Expression of Interest Form



Below is a detailed application form if you are interested in individual therapy with one of our practitioners. After filling out this form, you will receive an email where you can book directly for your free 30-minute consultation to discuss your needs.


Answering these questions saves us lots of time in your consultation. It will greatly assist in the process of understanding what you need from therapy, and also help us to match you to the right therapist. This will help you to progress much more quickly and enable us to help you achieve success.


All your answers will be kept confidential.


Make sure that you answer these questions as honestly and specifically as you can. It may be helpful to get into a peaceful and focused state to allow your unconscious mind to let the words flow……



Email* Country or state*
How did you hear about us?* Phone*
How would you like to do your free consultation*
What specific outcomes are you hoping to achieve from therapy?*
What has stopped you from being able to achieve these outcomes in the past?*
What does having this problem cost you? (think; finances, health, relationships, career, etc.)*
What positive things would happen if you were able to overcome this problem?*
This might seem like a strange question, but think hard. What negative things would happen if you were able to overcome this problem?*
What have you tried in the past to overcome this problem?*
Is there anything that we need to know about your mental health?*
Is there anything that we need to know about your physical health?*
Are you currently seeing any other practitioners or doctors for this problem?*
On a scale of 0-10, 10 being the highest, how committed are you to overcoming this problem?*
Answer this question without thinking about it too much. If you secretly knew why you were here on Earth or what your purpose is, what is it?*
If you decide to go ahead with a program of therapy, would you prefer your sessions via*
Is there anything else that you would like us to know?

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We would like to acknowledge the Wurundjeri people who are the Traditional Custodians of this land upon which Freedom from Food operates. We would also like to pay respect to the Elders both past and present of the Kulin Nation and extend that respect to other Indigenous Australians, past, and present.

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