INTUITIVE COACHING INTAKE

I would like to first honor you for taking this all important step towards sustainable wellbeing and freedom from limiting manifestations that have held you back caused you to shrink from your potential.

Together we will help you peel back the layers and find lasting expansion. But first I need to get a bit of background information. Please answer these questions in detail and with an open heart. Being vulnerable is easier for some than it is for others but vulnerability is an essential aspect of this process. Therefore I encourage you to answer each question with a deep reverance for your capacity to be vulnerable and with the knowledge that everything you submit is 200% secure and shared with no one. Because this is a modern therapeutic setting all that is shared is bound by both a spiritual and practical confidentiality. Barred any threats to the self or others nothing you share will be disclosed to any other body, official or otherwise.

if you are unsure how to answer a question please leave n/a and we will come back to it.

Name *

Name

First Name

Last Name

Email Address *

Date of Birth *

Percentage of day spent in the spiritual? *

If you had to average the amount of your day is devoted to spiritual pursuits, meditation, ritual, healing etc. what would that percentage be?

Percentage of day spent in obligation? *

How much of your day is spent tending to what you feel you "have" to do?

How much time do you feel is spent manifesting that which you don't want? *

Do you feel that most of your day is spent in a vibration/system of worth that is manifesting what you do not want? Or do you feel its fairly balanced between the two?

Relationship Status *

Please check the appropriate box

Married

Single

Domestic Partnership

What part of your being do you feel is most out of alignment? *

Mind, body, spirit or all areas?

What is the matter? *

Share what is presently bothering you here. What are you looking to iron out, transform or change?

Relationships with others *

Please list other important relationships in your life, the nature of the relationship as well as a descripter of said relationship. For example is the relationship close, just ok, poor or totally disengaged? Include parents, siblings, friends, lovers etc.

Are you currently diagnosed with a mental or emotional manifestation? *

This could include depression, social anxiety etc.

YES

Are you currently dependent upon substances? *

This includes both legal, illegal and prescription substances

YES

If yes, please list each substance and the age you began.

What is the highest level of education completed? *

High School

College

Post College

Do you feel your current level of edcation is sufficient for what you desire to do in your career? *

YES

Do you feel blocked in manifesting the life you desire? *

YES

If yes, please explain in detail.

Do you believe in the premise that you are a spiritual being having a physical experience? *

YES

Do you subscribe to a higher power? If so what do you call or label this higher power? *

Are any religious or spiritual beliefs causing guilt, shame, anger or any other affliction? *

YES

If yes please explain in detail.

Do you believe yourself to be an intuitive being? *

YES

UNDECIDED

What practices, if any do you devote to intuitive cultivation?

Do you feel you are on the right path? *

YES

Please explain in detail *

Have you come up with any of your own spiritual beliefs? If so please explain.

Do you meditate? *

YES

Are you pleased or satisfied with your soothing methods? *

How do you destress? How do you cope? How do you self soothe? Are you satisfied with these tactics or would you like additional support?

YES

Would like additional support

What have you manifested positively for yourself?

Are you energetically or emotionally sensitive? *

This includes being empathic and picking up on others emotions. Do you see auras? Do you pick up on the energy of other people or spaces?

YES

Please go into your sensitivities in detail.

What is your relationship with the body? *

Are you comfortable with your body? How do you treat your body?

How are you sleeping? *

Please get detailed in explaining your sleep routine, the quality of sleep and how frequently you awake in the night.

How would you rate your energy levels? *

What is your present level of self worth? *

Do you feel that you suffer from parental or caretaker wounds that are impacting your self worth? If so please explain in detail. *

Do you feel you are blocked by limiting beliefs? If so please explain. Are you aware of any of these beliefs? *

This physical experience would be great if.... *