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Thank you for considering me as a companion on this sacred and tender journey. This questionnaire is designed to help me understand your needs, values, and wishes. Whether you are seeking support for yourself or a loved one, my goal is to create a safe, compassionate space where you feel seen, heard, and supported.

The questions below will provide insight into your current situation, the type of care and guidance you’re looking for, and any preferences or concerns you’d like me to be aware of. There are no “right” or “wrong” answers—feel free to share as much or as little as feels comfortable for you.

Please know that all information shared is treated with the utmost respect and confidentiality.

I am honored to walk alongside you during this time, and I look forward to supporting you with presence, empathy, and care.

With warmth and compassion,