1:1 APPLICATION & INTAKE

For Be Enough, BE ENOUGH + BODY and other 1:1 work with Bec.

This is where we start.

Before we work together, I need a clear picture of your history, support system and nervous system so I can keep you safe and make sure this container is the right fit for you.

Take 5-10 minutes to fill this out as honestly as you can.

There are no perfect answers here - just your truth.

BEFORE YOU BEGIN

This form is for 1:1 work only (Be Enough, BE ENOUGH + BODY, or custom containers).

Everything you share is confidential within my professional and legal limits.
If something feels too much to write, you can say “I’d rather talk about this in session.”
This form is not crisis support. If you’re in immediate danger or considering harming yourself or someone else, please contact your GP, local emergency services or a mental health hotline first.

When you’re ready, scroll down and start with your details.

TELL ME ABOUT YOU

Client intake for 1:1 work

First name (as it appears on your drivers licence or passport)

Last name (as it appears on your drivers licence or passport)

Name at birth (if different)

Preferred Name

Date of birth

Month

Day

Year

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Occupation

Which program are you most interested in?

BE ENOUGH + BODY - 12-session in-person + online program (Tamborine, QLD)

Be Enough - 8-session online program

I’m not sure - I’d like your recommendation

Identify three of the most uplifting experiences you’ve encountered.

Recall three of your most challenging experiences.

Rate your Stress Level

10 – Extreme Stress: Overwhelmed and unable to cope, feeling like everything is out of control.

0 – No Stress: Completely calm and at peace, no stress or tension present.

Rate your Anxiety Level

10 – Extreme Anxiety: Overwhelmed and unable to cope, feeling like everything is out of control.

0 – No Anxiety: Completely calm and at peace, no stress or tension present.

Rate your Emotional Resilience

10 – Handle life's ups and downs extremely well.

0 – Handle life's ups and downs extremely poorly.

Self-Worth & Confidence (How confident do you feel in yourself and your abilities?)

10 – Extremely Confident.

0 – No confidence in self.

Mental Clarity & Focus (Do you feel clear-headed and able to focus?)

10 – Extremely Focussed

0 – No Focus or Clarity

Do you have a diagnosis (or suspect you have) for mental health conditions?

Medical Care

Are you receiving any therapeutic or pharmaceutical support

What do you do to self soothe?

Do you engage in any regular spiritual or religious practices?

What are your Primary Goals for this Program?

Are there particular issues or areas you wish to address?

What personal strengths or resources do you bring with you on this journey?

Do you have any questions or concerns about this program?

What are your expectations of our work together?

Is there anything else you want to share with me?

Which best describes paying for this work?

It feels comfortable - I can pay without stress.

It stretches me, but I can make it work.

It would feel very stressful or unsafe financially right now.

CLIENT ACKNOLEDGEMENT & RESPONSIBILITY

If we decide to work together, I can genuinely say “yes” to the following:

I can commit to the full container we agree on (8 or 12 sessions over ~16–20 weeks).

I understand this work can feel emotionally intense at times, and I’m willing to stay in the process and practise between sessions.

Paying for this work will not risk my basic needs (rent, food, safety) or put me in immediate financial danger.

If something changes and I can’t meet my commitments, I will communicate with Bec as early as possible.

INFORMED CONSENT

YES

I consent to participate in sessions and understand that I can withdraw from the program at any time.

I declare that the information I’ve provided is accurate and complete.

Signature

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Date and time

Month

Day

Year

Time

HoursMinutes