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REFLEKT Intake Form: A Mirror of Your Story
"You don’t need to have the right words. You just need to show up. A small memory, a feeling, even a sentence, it’s enough. This is your space to feel, not to explain."
Everything you say here is private and respected.❤️
Hey! Let's Begin With You
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Who is this reflection for?
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Who is this reflection for?
A
Myself
B
A friend/bestie
C
Partner
D
Family(Mom,Dad,Bro,Sis)
E
Someone I miss
F
Other:
If Selected Other Please specify 😇
SHARE YOUR STORY🫶
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Is there something you want to share, remember, or understand?
Or you want to give someone a gift by writing them a heartfelt letter and poem. Please share it here. Let's surprise your loved ones.
"I'd like to send you a reflection in the form of an email, which will include both a letter and a poem. Something truly significant is awaiting you."
Contact Info (So I Can Send Yours Back)
*
(Private. Nothing is Stored Only used to send your personalized reflection.)
Thank you, reflectors
