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Apply for
Private Therapy or Executive Coaching

Private, structured support for high-functioning working professionals & entrepreneurs ready for intentional depth work.

Before we schedule a consultation, I ask all prospective clients to complete a brief application.
 
This helps ensure alignment and allows me to understand your current stress load, goals, and readiness for this level of work.
 
Private therapy is structured and intentional.
 
It’s important that we are the right fit for each other.
 
If your application is aligned, I will personally follow up to schedule a consultation call.

Basic Information

Readiness & Goals

Which of the following best describes you? (Select all that apply)

Emotional & Nervous System Awareness

Are you currently in crisis or experiencing active suicidal thoughts?
Yes
No

If you are currently experiencing active suicidal thoughts or feel at risk of harming yourself, private outpatient therapy is not the appropriate level of care at this time.

Please seek immediate support through one of the following resources:

• Call or text 988 (Suicide & Crisis Lifeline – U.S.)

• Call 911 or go to your nearest emergency room

• Contact your local crisis center

If you are outside the U.S., please contact your local emergency services.

Your safety matters. Reaching out for immediate su

Commitment & Structure

Private therapy requires consistency and emotional engagement. Are you prepared to commit to regular sessions?
Yes
I'm unsure
Not at this time

Investment Transparency

Private therapy is private-pay. Are you comfortable investing in out-of-pocket services?
Yes
I would like more information
Not at this time

Created by Dr. Ernesha Smith

Holistic Therapist • Somatic Practitioner • Integration Guide

This space exists because healing deserves to feel safe, spacious, and human.

You don’t have to rush your becoming.

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