The Executive Reset|Pre-Session Intake

To maximize our 60 minutes together, please complete this brief audit.

Your responses are confidential and will help tailor the somatic protocols to your specific needs.

Upon clicking submit, you will be automatically redirected to my private calendar to select your time slot.

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Part 1: Current Status

1. How would you describe your current operating level? (Select one) *

2. Which physical symptoms show up most often for you? (Check all that apply) *

Waking up between 2 AM – 4 AM (Sleep disruption)

Jaw clenching or shoulder tension

Brain fog / Difficulty making decisions

Irritability / Short fuse with family or team

"Wired but tired" (Exhausted but can't relax)

Numbness / detachment

Tensed muscles

3. On a scale of 1-10, what is your current stress level regarding work? (1 = Zen, 10 = Panic/Crisis) *

Part 2: Session Goals

4. What is the PRIMARY stressor draining your battery right now? (Please be specific. Examples: "A toxic boss," "Fear of speaking up in meetings," "Overwhelmed by a specific project," "Guilt over saying no," "A high-stakes project," "Managing family demands," "Financial pressure," "A difficult relationship," or "General overwhelm.") *

5. If you could walk away from this session feeling ONE specific emotion, what would it be? (Example: "Calm," "Confident," "Quiet," "Clear")

Part 3: The Agreements

I understand that Martita is an EFT Practitioner in training and this session is for stress reduction and coaching purposes, not a substitute for psychotherapy or medical treatment.

I consent to this session being recorded for Martita’s private certification review only. (Recordings remain confidential and are never published).

I understand that this is a complimentary high-value session. If I need to cancel, I agree to provide 24-hour notice so another woman on the waitlist can take the spot.

Next Step: Upon clicking submit, you will be automatically redirected to my private calendar to select your time slot.
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The Executive Reset|Pre-Session Intake

Part 1: Current Status

Part 2: Session Goals

Part 3: The Agreements

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