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Intake Form
We look forward to meeting with you
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Select a date and time
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Full Name
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Email address
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Phone number
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What is your intention for this session?
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If you could name your deepest desire for healing, what would it be?
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Are there any recurring patterns, wounds, or life themes you feel ready to shift or release?
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What are some of the tools or practices (if any) that have supported you in the past on your healing journey?
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Do you currently work with any other healers, therapists, or practitioners? If so, please briefly share your support network.
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When you quiet the noise around you, what truths begin to surface from within?
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What parts of yourself have you outgrown, and what new ways of being are beginning to emerge?
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Are there inner voices or beliefs that seem to hold you back or keep you small?
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What are you longing for on the deepest level?
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Is there a moment, memory, or message that has stayed with you—something that seems to hold meaning even if you don’t fully understand why?
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Are you experiencing any physical symptoms or imbalances you would like to share?
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How do you currently relate to your body?
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Are you open to receiving intuitive touch (Reiki, light body work, etc.), as offered and appropriate?
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Is there anything that would make you feel especially safe, supported, or honored in our time together?
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Are there any boundaries or sensitivities I should be aware of (physical, emotional, spiritual, or energetic)?
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If you could name this chapter of your life, what would the title be?
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What would a meaningful shift in your life look or feel like after this session?
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Is there anything else you feel called to share before we meet?
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