Soul Retrieval Intake Form

Name: *

Date of Birth:

Email Address: *

Contact Phone Number: *

Emergency Contact (Name, Relationship & Phone Number): *

Is this your first time receiving a Soul Retrieval? *

Please select at least one option.

Yes.

No.

If the answer to the above question is "no," when was your last session, and what do you recall about it?

Do you hold any spiritual, ancestral, or cultural beliefs or practices that are important for me to be aware of before our session? *

Do you feel connected to a specific tradition, lineage, or unseen support (guides, ancestors, angels, star beings, etc.)? *

Are there any specific energies you wish to invite into the space with us? *

What is calling you to soul retrieval at this time? *

Are there certain moments, periods of your life, or emotional patterns that feel incomplete, disconnected, or unresolved? *

What are you noticing in your body, dreams, or emotions that feels connected to something deeper? *

Do you sense any part(s) of yourself that have been lost, hidden, silenced, or separated? If so, can you name or describe them? *

Are you currently receiving any emotional, psychological, or spiritual support (e.g., therapist, counselor, mentor, healer)? *

Are there wounds, traumas, or losses that feel tender or relevant as we open this portal together? *

What helps you feel safe, seen, and grounded when moving through emotional waters? *

How do you tend to process big energetic shifts (e.g., through movement, crying, writing, silence, etc.)? *

Do you have any current physical conditions, health concerns, or energetic imbalances you’d like me to be aware of? *

Are you pregnant or nursing? *

Please select at least one option.

Yes.

No.

Not applicable.

Are you taking any medications, supplements, or herbs? *

Please select at least one option.

Yes.

No.

If the answer to the above question is "yes," please list them here.

Do you have any sensitivities to sound, scent, touch, or other sensory input? *

Please select at least one option.

Yes.

No.

If the answer to the above question is "yes," please explain here.

Have you worked with altered states (e.g., breathwork, plant medicine, trance journeying) recently? *

Please select at least one option.

Yes.

No.

If the answer to the above question is "yes," please elaborate here.

What does “coming home to yourself” mean to you right now? *

Are there particular areas of your life where you long for more vitality, wholeness, or connection? Please explain. *

If a part of your soul were to return in this session, how would you want to welcome it? *

What support, practices, or spaces help you integrate change gently and meaningfully? *

Is there anything I should not do or say (energetically, verbally, emotionally) during the session? Please explain. *

Would you prefer to receive verbal guidance during the retrieval, or remain in silence unless Spirit prompts sharing? *

Do you give permission for me to journey and call home any soul parts that are ready to return? *

Please select at least one option.

Yes, I am ready.

No.

Are you open to the possibility of silence, stillness, and/or emotional release during our integration window? *

Please select at least one option.

Yes. I allow what needs to flow to do so.

No.

Is there anything else you’d like to share before we meet—any questions, fears, hopes, or visions you carry in your heart? *

I have completed this form truthfully and with care. *

Please select at least one option.

I affirm.

I understand that soul retrieval is a spiritual and energetic practice, and that integration is a sacred process unique to each person. *

Please select at least one option.

Yes, I understand.

Full Name (Typed Signature): *

Date: *

Eden