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Womb / Sacral Clearing | Client Intake Form
Please fulfill this questionnaire at least one day prior to your session in order to fully personalize & prepare your experience.
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What is your preferred name?
*
Your answer
What are your preferred pronouns?
She/Her
He/Him
They/Them
Other:
Clear selection
What is your email? This will be our main form of communication.
*
Your answer
What is your phone number? You will receive a reminder text prior to your session.
Your answer
How did you hear of this? If someone referred you, please share their name so they can be given referral reward credits :-)
Your answer
What word(s) feel most comfortable to you for us to use when referring to your body's reproductive center?
Womb
Sacral
Hara
Lower Belly
Other:
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