Step 2 of 4

Health information

Please check anything that applies. This information is confidential and helps ensure the session is safe and appropriate for you.

Current medications

List any medications you are currently taking, if relevant.

Anything else I should know?

Injuries, sensitivities, areas of focus, emotional context — anything that might be helpful.

Step 3 of 4

Informed consent

Please read and confirm each point below.

Please confirm all points above before signing.

Signature

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Step 4 of 4
🌸

Thank you, friend.

Your intake form is complete. I look forward to welcoming you to the session. If you have any questions beforehand, feel free to get in touch.