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The Inner Landscape — Client Application

Thank you for taking the time to apply! This form helps ensure that The Inner Landscape is a supportive and appropriate container for you right now. There are no “right” answers, truth matters most.

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Could you share a bit about yourself? ^*

First & Last Name ^*

Birthday ^*

Email ^*

Phone Number ^*

Pronouns

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What’s been happening in your life that’s leading you to seek this kind of support right now? ^*

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What are you hoping to gain from working with regulation tools and nervous-system-informed support? ^*

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This work involves practicing simple tools between sessions and engaging with the process actively. Are you open to this?

Yes

Unsure

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When challenges or discomfort arise, how do you typically respond? ^*

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This program is not crisis support, therapy, or a quick fix. Does this feel aligned with what you’re seeking right now? ^*

Yes

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Are you currently working with a therapist or mental health professional? ^*

Yes

I have in the past

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Are you currently experiencing a mental health crisis or seeking crisis-level support? ^*

If yes, you may not be a fit for this program at this time.

Yes

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Are you able to commit to a 4-week container with weekly sessions, during the weekday hours?

Yes

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Are you able to make the financial investment of $460 at this time? ^*

Yes

I’d like to discuss payment options

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Is there anything else you’d like me to know about you, your needs, your boundaries, or past?

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Consent and Acknowledgment ^*

I understand that The Inner Landscape is a nervous-system-informed support program, not therapy or crisis care.

I understand this work is collaborative, and I am responsible for my own engagement.

I understand that submitting this application does not guarantee acceptance.

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Never submit passwords Report abuse

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Thank you for applying!

Thank you for taking the time to complete your application for The Inner Landscape.

I review each application thoughtfully to ensure this work is supportive and aligned. You can expect to hear from me within 2–3 business days with next steps or to connect further.

There’s nothing else you need to do right now.
Please take care and move gently with yourself.

-Skye

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