COM|PASSionate REVOLT Consultations & Trainings

Hi there! I’m so glad that you’re reaching out for support in increasing your cultural competency! I’m a big believer in the importance of going beyond friendly, and even affirming care, to strive towards offering knowledgeable services for those you’re supporting so I really appreciate your time and investment.

Please, read over the questions below and answer with as much depth and honesty as you’re comfortable sharing. If we’ve had a previous communication, feel free to skip anything that doesn’t seem relevant. Looking forward to hearing more about your needs and seeing how I can help!

Name

First Name

Last Name

What are your preferred pronouns? (She, He, They, Other)

Phone

(###)

###

####

Please, let me know who will be attending this consultation/training. (For example, 10 clinicians working mainly with at risk youth or a staff of 15 realtors looking to increase their ability to work with LGBTQ Clients, etc.)

Tell me a bit about the case or area of knowledge around which you're seeking support.

Let me know a bit about the knowledge you already have and or places you've already looked into so I try to offer some new insight.

Anything else you'd like to share about what I could help you with?

Business Consultations

If this is a business consultation to grow your practice, please also fill out this following section:

Name and Company ( If separate)

Preferred Pronouns (She/He/They/Etc)

Website

http://

Social Media for Business

Current Sources of Income

Are you at your maximum earning potential?

Are you content with your current sources of income?

If not, can you explain why?

Describe your brand.

Think of it like a pitch - how would you tell a potential client/customer/therapist referral about what you do?

Where do you see yourself professionally in the next 3-6 months?

Where do you see yourself professionally in the next year? How about 5 years?

What do you enjoy most/least about your practice or profession?

What is success to you and how do you measure it?

What are three things that are working for you right now and nurturing your practice?

What are three things you're expending energy on but you're uncertain how helpful they are?

Anything else you'd like to share?