ELEMENTAL
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"The Elemental steps to creating more compassion, joy, and freedom in life." 

ELEMENTAL Intake Screening 


    This screening form is appropriate for individuals age-19 and above. 

    ​Only complete this screening if you are actively seeking treatment support.
    The screen takes approximately 30 minutes to complete and is best completed in a private and quiet space. 
    These questions may be triggering for some people, so please be kind to yourself and connect with a friend, spend time with a pet, or get out in nature. 

    Following submission, Michele will review the form then connect you to arrange a consultation or book a session.
    It is typical for the submission and review process to take 5 -to-7 business days
    .   

    Please take your time and check only those items that apply to you.
    Check the items that are mostly true of your current eating style
    Please take your time and check only those items that apply to you.
    Please take your time and check only those items that apply to you.
    Please take your time and check only those items that apply to you.
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