Fire & Water Alignment Intake

لم يتم تفعيل JavaScript في المتصفح، لذا لا يمكن فتح الملف. عليك تفعيلها وإعادة التحميل.

After you fill this out, I’ll be in touch to schedule a call. Then we can discuss pricing based on consistency and length of sessions that meet your needs. I offer 30/ 60 minutes sessions, weekly & monthly options with payment plans.
This form is used for adults, teens and children. Fill in as much or as little as appropriate for the age/ client.

يمكنك تسجيل الدخول إلى Google لحفظ مستوى التقدم. مزيد من المعلومات

Are you interested in sessions for you or a family member? Please indicate below and fill out for the client.

Name/ Pronouns/ Birthday/Age

Best Email / Cell Phone #

Occupation

ACES Score - Use the link to assess if you don't already know ( https://acestoohigh.com/got-your-ace-score/)

What is your intention with our sessions, and how do you envision it impacting your life ?

Please share all the self- care and support ( mental, physical, emotional, spiritual, etc) that you are currently working with OR have worked with in the past year. AND Please share about your current layers of support (trusted practitioners, healthy community, relationship with spirit, etc.)

List a few headlines of the healthiest parts of the timeline of your life and life today, within self and in relationship.

Describe your current health condition & relevant health/medical history, including near-death experiences, as well as information a practitioner should have before working with your body (significant challenge/trauma history like surgeries, car accidents, significant falls, etc.)

Describe your known relevant history of your ancestral headlines (like Holocaust, Slavery, The Depression, WW2, major health patterns)

What are your current movement and active embodiment practices? Please describe.

What are your current stillness and slower mindfulness practices? Please describe.

Any other notes, reflections or comments?

إرسال

محو النموذج

عدم إرسال كلمات المرور عبر نماذج Google مطلقًا.

لم يتم إنشاء هذا المحتوى ولا اعتماده من قِبل Google. الإبلاغ عن إساءة الاستخدام - شروط الخدمة - سياسة الخصوصية

نماذج